1023083672 NPI number — DR. LEON A WERTHEIMER DDS

Table of content: DR. LEON A WERTHEIMER DDS (NPI 1023083672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023083672 NPI number — DR. LEON A WERTHEIMER DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WERTHEIMER
Provider First Name:
LEON
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023083672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 SUMMIT LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALA CYNWYD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19004-2919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-667-2039
Provider Business Mailing Address Fax Number:
610-667-8089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
352 MONTGOMERY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERION
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19066-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-668-0606
Provider Business Practice Location Address Fax Number:
610-668-8427
Provider Enumeration Date:
02/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS 019271-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)