MEDICARE: DR. LEONARD V AGOSTINO DC

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
1	111N00000X	Chiropractor	DC001210L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	116084	OTHER	PA	BCBS

General Provider Information

NPI Number	:	1568457091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD V AGOSTINO DC

Provider Business Mailing Address
First Line	:	730 5TH AVE
Second Line	:
City	:	NEW KENSINGTON
State	:	PA
Zip	:	15068-6302
Country	:	US
Telephone Number	:	724-339-1221
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 5TH AVE
Second Line	:
City	:	NEW KENSINGTON
State	:	PA
Zip	:	15068-6302
Country	:	US
Telephone Number	:	724-339-1221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	07/09/2007

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Directions to “ DR. LEONARD V AGOSTINO DC” Practice Location

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