Healthcare Provider Details

I. General information

NPI: 1922538016
Provider Name (Legal Business Name): LESHAN LEE BRONISZEWSKI-BURLINGHAM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 03/26/2025
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NORTH JAMES STREET
ROME NY
13440-2844
US

IV. Provider business mailing address

245 AVERY LN
ROME NY
13441-4237
US

V. Phone/Fax

Practice location:
  • Phone: 315-338-7040
  • Fax: 315-338-7215
Mailing address:
  • Phone: 315-337-1200
  • Fax: 315-337-7614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341765
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: