Provider Demographics
NPI:1073511580
Name:LEFKOWITZ, KENNETH RUSSELL (DPM)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RUSSELL
Last Name:LEFKOWITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 SWAMP ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901
Mailing Address - Country:US
Mailing Address - Phone:215-230-9707
Mailing Address - Fax:215-230-4660
Practice Address - Street 1:252 SWAMP RD.
Practice Address - Street 2:STE. 2
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901
Practice Address - Country:US
Practice Address - Phone:215-230-9707
Practice Address - Fax:215-230-4660
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003778R213EP1101X, 213E00000X, 213ES0131X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013957020002Medicaid
PALE485431Medicare PIN
PA0013957020002Medicaid
PAU37160Medicare UPIN