Provider Demographics
NPI:1861575201
Name:WELSCH, LESLIE RAND
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:RAND
Last Name:WELSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2920
Mailing Address - Country:US
Mailing Address - Phone:631-549-0610
Mailing Address - Fax:631-351-8479
Practice Address - Street 1:226 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2920
Practice Address - Country:US
Practice Address - Phone:631-549-0610
Practice Address - Fax:631-351-8479
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005324-1133NN1002X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Not Answered133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2541942OtherOXFORD PROVIDER ID#
NYAZ00422OtherMDNY PROVIDER ID#
NY125356POtherHIP PROVIDER ID#
NY287735OtherVYTRA ID#
NY7101452OtherAETNA ID#
NYP2541942OtherOXFORD PROVIDER ID#
NYP74086Medicare UPIN