Provider Demographics
NPI:1528309317
Name:JEFFREY C. LEATHERSICH PA, PLLC
Entity type:Organization
Organization Name:JEFFREY C. LEATHERSICH PA, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:LEATHERSICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:585-748-1820
Mailing Address - Street 1:3300 MONROE AVE STE 345
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4625
Mailing Address - Country:US
Mailing Address - Phone:585-381-9966
Mailing Address - Fax:585-381-7594
Practice Address - Street 1:3300 MONROE AVE STE 345
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4625
Practice Address - Country:US
Practice Address - Phone:585-381-9966
Practice Address - Fax:585-381-7594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Multi-Specialty