Provider Demographics
NPI:1881814580
Name:LEON E. GOSCINIAK D.O.,P.C.
Entity type:Organization
Organization Name:LEON E. GOSCINIAK D.O.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOSCINIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-785-3300
Mailing Address - Street 1:705 STATE RD
Mailing Address - Street 2:
Mailing Address - City:CROYDON
Mailing Address - State:PA
Mailing Address - Zip Code:19021-7446
Mailing Address - Country:US
Mailing Address - Phone:215-785-3300
Mailing Address - Fax:215-785-0818
Practice Address - Street 1:705 STATE RD
Practice Address - Street 2:
Practice Address - City:CROYDON
Practice Address - State:PA
Practice Address - Zip Code:19021-7446
Practice Address - Country:US
Practice Address - Phone:215-785-3300
Practice Address - Fax:215-785-0818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004147L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0022558001OtherKEYSTONE HEALTH PLAN EAST
PA165839OtherINDEPENDENCE BLUE CROSS
PA165839OtherHIGHMARK BLUE SHIELD
PA1700820040OtherNPI PROVIDER NUMBER
PA0022558001OtherAMERIHEALTH INS.CO.N.J.
PA0022558001OtherPERSONAL CHOICE
PA0022558001OtherAMERIHEALTH HMO N.J.
PA000675962003Medicaid
PA0022558001OtherAMERIHEALTH INS.CO.N.J.
PAB40500Medicare UPIN