Provider Demographics
NPI:1588645402
Name:PORTNOY, LEONARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:PORTNOY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 DAVISVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-3020
Mailing Address - Country:US
Mailing Address - Phone:215-357-4112
Mailing Address - Fax:215-364-8873
Practice Address - Street 1:840 DAVISVILLE RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-3020
Practice Address - Country:US
Practice Address - Phone:215-357-4112
Practice Address - Fax:215-364-8873
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASCOO1296L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT27563Medicare UPIN
PA0581990001Medicare NSC