Provider Demographics
NPI:1588980288
Name:SMALL-HARARY, LESLEY (MD)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:SMALL-HARARY
Suffix:
Gender:F
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:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-8115
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK CHILDRENS HOSPITAL
Practice Address - Street 2:HSC LEVEL 11 RM 080
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8111
Practice Address - Country:US
Practice Address - Phone:631-444-8115
Practice Address - Fax:631-444-6045
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268402208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics