1477721884 NPI number — MR. LARRY BRUCE LEVY RPH

Table of content: MR. LARRY BRUCE LEVY RPH (NPI 1477721884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477721884 NPI number — MR. LARRY BRUCE LEVY RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVY
Provider First Name:
LARRY
Provider Middle Name:
BRUCE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
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:
1477721884
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 CARLING DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11040-3721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-249-0275
Provider Business Mailing Address Fax Number:
516-294-3763

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2305 JERICHO TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN CITY PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11040-4709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-741-1510
Provider Business Practice Location Address Fax Number:
516-248-2373
Provider Enumeration Date:
02/19/2008

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: 183500000X , with the licence number:  30529 , 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: 30529 . This is a "RPH STATE LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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