Healthcare Provider Details

I. General information

NPI: 1073511580
Provider Name (Legal Business Name): KENNETH RUSSELL LEFKOWITZ DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 SWAMP RD. STE. 2
DOYLESTOWN PA
18901
US

IV. Provider business mailing address

252 SWAMP ROAD SUITE 2
DOYLESTOWN PA
18901
US

V. Phone/Fax

Practice location:
  • Phone: 215-230-9707
  • Fax: 215-230-4660
Mailing address:
  • Phone: 215-230-9707
  • Fax: 215-230-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC003778R
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC003778R
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberSC003778R
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: