Healthcare Provider Details

I. General information

NPI: 1194983429
Provider Name (Legal Business Name): LESLY GRACIA MICHEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 BEACH 20TH ST
FAR ROCKAWAY NY
11691-3621
US

IV. Provider business mailing address

327 BEACH 19TH ST
FAR ROCKAWAY NY
11691-4423
US

V. Phone/Fax

Practice location:
  • Phone: 347-619-5950
  • Fax:
Mailing address:
  • Phone: 347-619-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number251187
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number251187
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: