Individual
DR. LESLAW J GREDYSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
31 MAIN RD, SUITE 2, RIVERHEAD, NY 11901
(631) 369-8539
(631) 369-5613
Mailing address
31 MAIN RD, SUITE 2, RIVERHEAD, NY 11901
(631) 369-8539
(631) 369-5613
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
175169
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01465594
—
NY
01
—
35085
VYTRA
NY
01
—
738310
AETNA
NY
Enumeration date
09/14/2006
Last updated
11/14/2007
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