Provider Demographics
NPI:1528063492
Name:HUSZAR, LESLIE A (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:A
Last Name:HUSZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7390 45TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-7708
Mailing Address - Country:US
Mailing Address - Phone:772-299-8422
Mailing Address - Fax:772-365-0861
Practice Address - Street 1:3725 10TH CT
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6559
Practice Address - Country:US
Practice Address - Phone:772-299-8422
Practice Address - Fax:772-365-0861
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00570232084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110011008OtherRAILROAD MEDICARE
NY399371OtherEMPIRE BCBS OF NY
PA993193OtherBLUE SHIELD OF PA
FL27901OtherBC BS OF FLORIDA
PA993193OtherBLUE SHIELD OF PA
FL27901Medicare ID - Type Unspecified