Provider Demographics
NPI:1114461514
Name:FOOT PAIN MANAGEMENT INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FOOT PAIN MANAGEMENT INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-980-3073
Mailing Address - Street 1:5907 LANKERSHIM BLVD
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-1006
Mailing Address - Country:US
Mailing Address - Phone:818-980-3073
Mailing Address - Fax:
Practice Address - Street 1:5907 LANKERSHIM BLVD
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-1006
Practice Address - Country:US
Practice Address - Phone:818-980-3073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1360213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE1360OtherCALIFORNIA MEDICAL BOARD