Provider Demographics
NPI:1073547410
Name:MENAKER, LEONARD (DPM)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:MENAKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:LEONARD
Other - Middle Name:
Other - Last Name:MENAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1628 JOHN F KENNEDY BLVD
Mailing Address - Street 2:SUITE # 2100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-2125
Mailing Address - Country:US
Mailing Address - Phone:215-563-9478
Mailing Address - Fax:215-563-2301
Practice Address - Street 1:1628 JOHN F KENNEDY BLVD
Practice Address - Street 2:SUITE # 2100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-2125
Practice Address - Country:US
Practice Address - Phone:215-563-9478
Practice Address - Fax:215-563-2301
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001390L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA042204HUROtherRENDERING PHYSICIAN PIN
PA0032689000OtherPERSONAL CHOICE
NJ0656649000OtherAMERIHEALTH
NJ090571OtherNATIONAL GOVERNMENT SERVI
PAME042204OtherHIGHMARK BLUE SHIELD
PA467160Medicare PIN
NJ0656649000OtherAMERIHEALTH
PA0032689000OtherPERSONAL CHOICE