Healthcare Provider Details

I. General information

NPI: 1841234226
Provider Name (Legal Business Name): LEON JAY REZNIK D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 FRANKFORD AVE SUITE 2
PHILA PA
19124-2620
US

IV. Provider business mailing address

5000 FRANKFORD AVE SUITE 2
PHILA PA
19124-2620
US

V. Phone/Fax

Practice location:
  • Phone: 215-533-0632
  • Fax: 215-831-1494
Mailing address:
  • Phone: 215-533-0632
  • Fax: 215-831-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC002489L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: