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General NPI Number Information
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NPI Number | 1528309317
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Entity Type | Organization
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Legal Business Name | JEFFREY C. LEATHERSICH PA, PLLC
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 3300 MONROE AVE STE 345
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City | ROCHESTER
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State | NY
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Zip | 14618-4625
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Country | US
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Telephone | 585-381-9966
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Fax | 585-381-7594
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Provider Business Mailing Address
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Address Line | 3300 MONROE AVE STE 345
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City | ROCHESTER
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State | NY
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Zip | 14618-4625
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Country | US
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Telephone | 585-381-9966
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Fax | 585-381-7594
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JEFFREY CHRISTIAN LEATHERSICH
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Credential | PHYSICIAN ASSISTANT
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Telephone | 585-748-1820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 132700000X
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Taxonomy Name | Dietary Manager
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License Number |
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License Number State |
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