Provider Demographics
NPI:1992708846
Name:BROSTOFF, LEON M (MD)
Entity type:Individual
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First Name:LEON
Middle Name:M
Last Name:BROSTOFF
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Gender:M
Credentials:MD
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Mailing Address - Street 1:11279 PERRY HWY
Mailing Address - Street 2:STE 450
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9303
Mailing Address - Country:US
Mailing Address - Phone:724-933-1100
Mailing Address - Fax:724-933-1160
Practice Address - Street 1:2790 MOSSIDE BLVD
Practice Address - Street 2:STE 700
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2758
Practice Address - Country:US
Practice Address - Phone:412-380-9250
Practice Address - Fax:412-380-9253
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PAMD028937E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010381790008Medicaid
PAB41775Medicare UPIN