Provider Demographics
NPI:1134179047
Name:GREENWALD, LEONARD (DPM)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:GREENWALD
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 1:750 N CAPITOL AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1913
Mailing Address - Country:US
Mailing Address - Phone:408-926-5855
Mailing Address - Fax:408-926-2544
Practice Address - Street 1:750 N CAPITOL AVE
Practice Address - Street 2:SUITE B3
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1913
Practice Address - Country:US
Practice Address - Phone:408-926-5855
Practice Address - Fax:408-926-2544
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1982213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT11117Medicare UPIN
CAZZZ75770ZMedicare PIN