Healthcare Provider Details

I. General information

NPI: 1053947085
Provider Name (Legal Business Name): RUBEN LESNICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 BROADWAY
SEATTLE WA
98122-4379
US

IV. Provider business mailing address

173 PROSPECT ST
PROVIDENCE RI
02906-1434
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-2123
  • Fax: 206-386-6293
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberML61163570
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: