MEDICARE: MEAGHAN MARY LEDETSCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	707307	NY

General Provider Information

NPI Number	:	1013847805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGHAN MARY LEDETSCH

Provider Business Mailing Address
First Line	:	3 CHICAGO AVE
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-4420
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 BURKE LN
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-3932
Country	:	US
Telephone Number	:	516-941-8115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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Directions to “ MEAGHAN MARY LEDETSCH ” Practice Location

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