Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC001390L | PA |
Y | 222Z00000X | Podiatrist | SC001390L | PA |
NPI | 1073547410 |
---|---|
Provider Name | Dr. Leonard Menaker |
First Address | Philadelphia, PA 19103-2125 |
Second Address | Philadelphia, PA 19103-2125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 10/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0032689000 | PERSONAL CHOICE (01) | PA |
042204HUR | RENDERING PHYSICIAN PIN (01) | PA |
0656649000 | AMERIHEALTH (01) | NJ |
090571 | NATIONAL GOVERNMENT SERVI (01) | NJ |
ME042204 | HIGHMARK BLUE SHIELD (01) | PA |
T72395 | (02) | PA |