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NPI Code Detail

MEDICARE: DR. LEON SERCHUK M.D.

MEDICARE: DR. LEON SERCHUK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician154652NY

General Provider Information

NPI Number : 1285617340
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LEON SERCHUK M.D.
Provider Business Mailing Address
First Line : 11995 SINGLETREE LN
Second Line : SUITE 500
City : EDEN PRAIRIE
State : MN
Zip : 55344-5347
Country : US
Telephone Number : 952-595-1301
Fax Number : 612-294-4903
Provider Business Practice Location Address
First Line : 101 HOSPITAL RD
Second Line :
City : PATCHOGUE
State : NY
Zip : 11772-4870
Country : US
Telephone Number : 952-595-1100
Fax Number : 612-294-4903
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2005
Last Update Date : 10/02/2013

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