Provider Demographics
NPI:1841234226
Name:REZNIK, LEON JAY (DPM)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:JAY
Last Name:REZNIK
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 1:5000 FRANKFORD AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2620
Mailing Address - Country:US
Mailing Address - Phone:215-533-0632
Mailing Address - Fax:215-831-1494
Practice Address - Street 1:5000 FRANKFORD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19124-2620
Practice Address - Country:US
Practice Address - Phone:215-533-0632
Practice Address - Fax:215-831-1494
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002489L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0859128Medicaid
PAT28309Medicare UPIN
PA0859128Medicaid
PA084058Medicare PIN