Provider Demographics
NPI:1326080896
Name:LEONID MAGIDENKO, MD, PC
Entity Type:Organization
Organization Name:LEONID MAGIDENKO, MD, PC
Other - Org Name:HEALTH SMART MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGIDENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-464-6040
Mailing Address - Street 1:518 BUSTLETON PIKE FL 1
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6035
Mailing Address - Country:US
Mailing Address - Phone:215-464-6040
Mailing Address - Fax:215-464-6046
Practice Address - Street 1:518 BUSTLETON PIKE FL 1
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6035
Practice Address - Country:US
Practice Address - Phone:215-464-6040
Practice Address - Fax:215-464-6046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA063536Medicare ID - Type Unspecified