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General NPI Number Information
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NPI Number | 1326478777
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Entity Type | Organization
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Legal Business Name | LESLIE KOROSTOFF MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/22/2013
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 191 S BUENA VISTA ST SUITE 340
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City | BURBANK
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State | CA
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Zip | 91505-4554
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Country | US
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Telephone | 818-260-0693
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Fax |
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Provider Business Mailing Address
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Address Line | 1931 HAMPTON LN
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City | GLENDALE
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State | CA
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Zip | 91201-1107
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Country | US
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Telephone | 818-391-9060
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LESLIE KOROSTOFF
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Credential | MD
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Telephone | 818-391-9060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A96824
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License Number State | CA
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