Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | MD-036617-E | PA |
Y | 207KA0200X | Allergist | MD-036617-E | PA |
NPI | 1518949130 |
---|---|
Provider Name | Dr. Jakub Lekach |
First Address | Dunmore, PA 18512-2481 |
Second Address | Dunmore, PA 18512-2481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 29/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A60324 | (02) | PA |