Provider Demographics
NPI:1093171019
Name:LEON P PERLSTEIN, D.P.M., P.A.
Entity Type:Organization
Organization Name:LEON P PERLSTEIN, D.P.M., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:PERLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:754-666-3338
Mailing Address - Street 1:2520 MARINA BAY DR E APT 104
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-2322
Mailing Address - Country:US
Mailing Address - Phone:786-315-1111
Mailing Address - Fax:754-200-6057
Practice Address - Street 1:5961 NW 61ST AVE APT 101
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-2217
Practice Address - Country:US
Practice Address - Phone:754-666-3338
Practice Address - Fax:754-200-6057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3054213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16566000Medicaid
FL16566000Medicaid
FLIO283BMedicare UPIN