1639642473 NPI number — NICOLA SUSANNE LEVSTIK MBBCHBAO

Table of content: NICOLA SUSANNE LEVSTIK MBBCHBAO (NPI 1639642473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639642473 NPI number — NICOLA SUSANNE LEVSTIK MBBCHBAO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVSTIK
Provider First Name:
NICOLA
Provider Middle Name:
SUSANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MBBCHBAO
Provider Gender Code:
F

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:
1639642473
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 PANORAMA TRL
Provider Second Line Business Mailing Address:
BLDG 3, STE 100
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-276-9361
Provider Business Mailing Address Fax Number:
585-248-3703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 PANORAMA TRL
Provider Second Line Business Practice Location Address:
BLDG 3, STE 100
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-276-9361
Provider Business Practice Location Address Fax Number:
585-248-3703
Provider Enumeration Date:
01/04/2019

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: 207R00000X , with the licence number:  297962 , 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)





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