Healthcare Provider Details

I. General information

NPI: 1649197062
Provider Name (Legal Business Name): MARY LERCZAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 LUDLOWVILLE RD
LANSING NY
14882-9040
US

IV. Provider business mailing address

6 LUDLOWVILLE RD
LANSING NY
14882-9040
US

V. Phone/Fax

Practice location:
  • Phone: 716-533-3020
  • Fax: 607-533-4851
Mailing address:
  • Phone: 607-533-3020
  • Fax: 607-533-4851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number581839
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: