1558391565 NPI number — LEONARD MENAKER

Table of content: (NPI 1558391565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558391565 NPI number — LEONARD MENAKER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEONARD MENAKER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RITTENHOUSE PODIATRY ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1558391565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1628 JOHN F KENNEDY BLVD
Provider Second Line Business Mailing Address:
SUITE # 2100
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19103-2125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-563-9478
Provider Business Mailing Address Fax Number:
215-563-2301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1628 JOHN F KENNEDY BLVD
Provider Second Line Business Practice Location Address:
SUITE # 2100
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19103-2125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-563-9478
Provider Business Practice Location Address Fax Number:
215-563-2301
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MENAKER
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-563-9478

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  SC001390L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0103X , with the licence number: SC001390L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1762853 . This is a "HIGHMARK BS OF NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2429886000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 467160 . This is a "HIGHMARK BS OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0285802000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 098651 . This is a "NATIONAL GOV'T SERVICES" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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