Healthcare Provider Details

I. General information

NPI: 1073547410
Provider Name (Legal Business Name): LEONARD MENAKER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LEONARD MENAKER D.P.M.

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 JOHN F KENNEDY BLVD SUITE # 2100
PHILADELPHIA PA
19103-2125
US

IV. Provider business mailing address

1628 JOHN F KENNEDY BLVD SUITE # 2100
PHILADELPHIA PA
19103-2125
US

V. Phone/Fax

Practice location:
  • Phone: 215-563-9478
  • Fax: 215-563-2301
Mailing address:
  • Phone: 215-563-9478
  • Fax: 215-563-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC001390L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: