Provider Demographics
NPI:1336891118
Name:LEHTIKOSKI, ANTONY
Entity type:Individual
Prefix:
First Name:ANTONY
Middle Name:
Last Name:LEHTIKOSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10465 SAINT SIMONDS CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6026
Mailing Address - Country:US
Mailing Address - Phone:470-774-6416
Mailing Address - Fax:
Practice Address - Street 1:859 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1752
Practice Address - Country:US
Practice Address - Phone:215-750-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-22
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0011712363AM0700X
PAMA063427363AM0700X
NJ25MP00708300363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical