1467537860 NPI number — STEPHEN M LEVINE MD

Table of content: STEPHEN M LEVINE MD (NPI 1467537860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467537860 NPI number — STEPHEN M LEVINE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVINE
Provider First Name:
STEPHEN
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:
1467537860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13505 NW COCO PLUM CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34990-4832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-642-2133
Provider Business Mailing Address Fax Number:
856-642-2134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 FELLOWSHIP RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MOUNT LAUREL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08054-3419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-642-2133
Provider Business Practice Location Address Fax Number:
856-642-2134
Provider Enumeration Date:
10/25/2006

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: 207RG0100X , with the licence number:  MA22959 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100017145 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3K6137 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 93364 . This is a "AMERIHEALTH PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 93364 . This is a "PA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0343501 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1621516 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3605744 . This is a "OXFORD HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0078604000 . This is a "AMERIHEALTH HMO, KEYSTONE , IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010004719 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0297325 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1171016 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20566 . This is a "UNIVERSITY HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3056608 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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