Basic Information
| Provider Information | |||||||||
| NPI: | 1720240369 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LESNESKI | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15000 MIDLANTIC DRIVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562555479 | ||||||||
| FaxNumber: | 8563938691 | ||||||||
| Practice Location | |||||||||
| Address1: | 15000 MIDLANTIC DRIVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562555479 | ||||||||
| FaxNumber: | 8563938691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2008 | ||||||||
| LastUpdateDate: | 04/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MT192442 | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | 25MA09267600 | NJ | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.