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General NPI Number Information
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NPI Number | 1841234226
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Entity Type | Individual
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Provider Name | LEON JAY REZNIK D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 5000 FRANKFORD AVE SUITE 2
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City | PHILA
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State | PA
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Zip | 19124-2620
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Country | US
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Telephone | 215-533-0632
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Fax | 215-831-1494
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Provider Business Mailing Address
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Address Line | 5000 FRANKFORD AVE SUITE 2
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City | PHILA
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State | PA
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Zip | 19124-2620
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Country | US
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Telephone | 215-533-0632
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Fax | 215-831-1494
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC002489L
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License Number State | PA
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