1437120714 NPI number — RICHARD LEVY

Table of content: RICHARD LEVY (NPI 1437120714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437120714 NPI number — RICHARD LEVY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVY
Provider First Name:
RICHARD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1437120714
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 LATHAM CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAUGERTIES
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12477-4213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-247-3227
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 NORTHWAY LN
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LATHAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12110-4815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-786-1291
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2006

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: 2085R0202X , with the licence number:  178570 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085N0700X , with the licence number: 178570 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 02743864 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com