Provider Demographics
NPI:1033114483
Name:ROSENKRANZ, LEON GUSTAV (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:GUSTAV
Last Name:ROSENKRANZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 S GULFSTREAM AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-6736
Mailing Address - Country:US
Mailing Address - Phone:718-974-7518
Mailing Address - Fax:718-273-9664
Practice Address - Street 1:435 S GULFSTREAM AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-6736
Practice Address - Country:US
Practice Address - Phone:718-974-7518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL123694207R00000X
NY128439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY128439OtherNY STATE MEDICAL LICENSE
NY00319897Medicaid
FL123694OtherFLORIDA MEDICAL LICENSE
NY350021Medicare ID - Type Unspecified