Leon Edmund Gosciniak, D.O.
Individual provider Active NPI General Practice Physician · Croydon, PA
NPI 1700820040 · NPPES record last updated Jan 29, 2016
Key facts
- NPI
- 1700820040
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- OS004147L (PA)
- Practice address
- 705 State Rd
Croydon, PA 19021-7446 - Phone
- (215) 785-3300
- Fax
- (215) 785-0818
- NPI assigned
- Jun 16, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS004147L | PA | MD | General Practice Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | OS004147L | PA | Yes |
Addresses
Primary practice location
705 State Rd
Croydon, PA 19021-7446
Mailing address
705 State Rd
Croydon, PA 19021-7446
Phone (215) 785-3300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000675962 | Medicaid | PA |
Other providers in Croydon, PA
- Diagnostic Experts LLC
- Linda Diernbach
- Jennifer Jacqueline Dowe
- Family Service Association
- Laura Fradkin
- Eugenia Jivka Guteff
- Lauren Marie Hilbert
- Kristin Marie King
- Madison Konyves
- Thomas Martin Krause
All providers in Croydon, PA · General Practice Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.