Provider Demographics
NPI:1124212691
Name:HOWARD LEUCHTAG INC
Entity Type:Organization
Organization Name:HOWARD LEUCHTAG INC
Other - Org Name:HOWARD SHOES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:AL
Authorized Official - Last Name:LEUCHTAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-831-3322
Mailing Address - Street 1:27085 CHAGRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODMERE VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-831-3322
Mailing Address - Fax:216-831-5969
Practice Address - Street 1:27085 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:WOODMERE VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-831-3322
Practice Address - Fax:216-831-5969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0826540001Medicare NSC