Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 055613 | NY |
N | 1223P0221X | Pediatric Dentist | 11259 | CT |
NPI | 1013228287 |
---|---|
Provider Name | Khrystyna Leskiv |
First Address | Bronx, NY 10453-8202 |
Second Address | Bronx, NY 10453-8202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2010 |
Last Update Date | 10/03/2017 |