Provider Demographics
NPI:1568457091
Name:AGOSTINO, LEONARD V (DC)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:V
Last Name:AGOSTINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-6302
Mailing Address - Country:US
Mailing Address - Phone:724-339-1221
Mailing Address - Fax:
Practice Address - Street 1:730 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-6302
Practice Address - Country:US
Practice Address - Phone:724-339-1221
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001210L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA116084OtherBCBS
PA1160804Medicare ID - Type UnspecifiedMEDICARE
PAT26177Medicare UPIN