Provider Demographics
NPI:1043409345
Name:LEONARD GREENWALD, DPM
Entity Type:Organization
Organization Name:LEONARD GREENWALD, DPM
Other - Org Name:BERRYESSAY HILLS PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:408-926-5855
Mailing Address - Street 1:750 N CAPITOL AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1913
Mailing Address - Country:US
Mailing Address - Phone:408-926-5855
Mailing Address - Fax:408-926-2544
Practice Address - Street 1:750 N CAPITOL AVE
Practice Address - Street 2:SUITE B3
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1913
Practice Address - Country:US
Practice Address - Phone:408-926-5855
Practice Address - Fax:408-926-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1982261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ75770ZMedicare UPIN