1669529186 NPI number — JEFFREY M LEVINE MD

Table of content: JEFFREY M LEVINE MD (NPI 1669529186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669529186 NPI number — JEFFREY M LEVINE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVINE
Provider First Name:
JEFFREY
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:
1669529186
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
928 BROADWAY
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10010-6008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-253-5601
Provider Business Mailing Address Fax Number:
212-253-6602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
928 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10010-6008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-253-5601
Provider Business Practice Location Address Fax Number:
212-253-6602
Provider Enumeration Date:
01/05/2007

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: 207RG0300X , with the licence number:  158288 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0300X , with the licence number: 41410 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 04482 . This is a "GHI NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01126310 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".