1457563520 NPI number — STEVEN A. LEVY, DPM, PC

Table of content: (NPI 1457563520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457563520 NPI number — STEVEN A. LEVY, DPM, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN A. LEVY, DPM, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1457563520
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
297 KINDERKAMACK RD
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
ORADELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07649-1538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-261-7407
Provider Business Mailing Address Fax Number:
201-261-7409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
297 KINDERKAMACK RD
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
ORADELL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07649-1538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-261-7407
Provider Business Practice Location Address Fax Number:
201-261-7409
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEVY
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
201-261-7407

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  MD001796 , 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: 1407831126 . This is a "NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: A100000760 . This is a "NY MEDICARE PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 480024499 . This is a "RR MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 542593W0B . This is a "IND PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: A400007052 . This is a "NY MEDICARE PIN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0160890 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: DG9621 . This is a "RR MEDICARE GROUP PTAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1366438442 . This is a "NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: A400006903 . This is a "NY MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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