Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | SCOO1296L | PA |
NPI | 1588645402 |
---|---|
Provider Name | Dr. Leonard Portnoy |
First Address | Warminster, PA 18974-3020 |
Second Address | Warminster, PA 18974-3020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 02/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T27563 | (02) | PA |