1669465233 NPI number — ELLIOT M LEVINE MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669465233 NPI number — ELLIOT M LEVINE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVINE
Provider First Name:
ELLIOT
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669465233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 MIDDLEBUSH RD
Provider Second Line Business Mailing Address:
SUITE U-306
Provider Business Mailing Address City Name:
WAPPINGERS FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12590-4098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-297-6450
Provider Business Mailing Address Fax Number:
845-297-6160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 MIDDLEBUSH RD
Provider Second Line Business Practice Location Address:
SUITE U-306
Provider Business Practice Location Address City Name:
WAPPINGERS FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12590-4098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-297-6450
Provider Business Practice Location Address Fax Number:
845-297-6160
Provider Enumeration Date:
08/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  201852 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 117063 . This is a "MVP HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2018521 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01654466 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P495454 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10031790 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5460423 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 14N011 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2506422 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2C7584 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 432704N . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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