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Contact Information

LESLAW J GREDYSA, MD
31 MAIN RD
SUITE 2
RIVERHEAD, NY11901
 Phone: 631-369-8539
 Fax: 631-369-5613
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Vascular Surgery

2086S0129X 76 Physician/Peripheral Vascular Disease
Indicates primary specialty

NPI Profile & details for LESLAW J GREDYSA · (Male)

NPI # 1184729998
Status Active
Credentials MD
Entity Individual
Enumeration date 09/14/2006
Last updated 11/14/2007 - About 19 years ago
Sole proprietor 1 No
Identifiers
  • NY License # 175169
  • NY Medicaid 01465594
  • NY Other 738310 AETNA
  • NY Other 35085 VYTRA
Hospital affiliation(s)
  • PECONIC BAY MEDICAL CENTER - (Acute Care)
    1300 ROANOKE AVENUE
    RIVERHEAD, NY 11901
  • UNIVERSITY HOSPITAL ( STONY BROOK ) - (Acute Care)
    HEALTH SCIENCES CENTER SUNY
    STONY BROOK, NY 11794
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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