Individual
LESLY GRACIA MICHEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
495 BEACH 20TH ST, FAR ROCKAWAY, NY 11691-3621
(347) 619-5950
Mailing address
327 BEACH 19TH ST, FAR ROCKAWAY, NY 11691-4423
(347) 619-5950
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
251187
NY
2080P0205X
Pediatric Endocrinology Physician
Primary
251187
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03404868
—
NY
01
—
251187
LICENSE
NY
Enumeration date
05/22/2008
Last updated
07/21/2022
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