1659453017 NPI number — STEPHEN A LEVIN MD

Table of content: STEPHEN A LEVIN MD (NPI 1659453017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659453017 NPI number — STEPHEN A LEVIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVIN
Provider First Name:
STEPHEN
Provider Middle Name:
A
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:
1659453017
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 COOPER PLZ
Provider Second Line Business Mailing Address:
SUITE 502
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08103-1438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-968-7433
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 COOPER PLZ
Provider Second Line Business Practice Location Address:
COOPER UNIVERSITY RADIOLOGY
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08103-1461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-342-2382
Provider Business Practice Location Address Fax Number:
856-365-0472
Provider Enumeration Date:
10/19/2006

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: 2085B0100X , with the licence number:  MA24332 , 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: 105533 . This is a "PA BS HIGHMARK" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0079797000 . This is a "AMERIHEALTH/KEYSTONE/IBC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 105533 . This is a "AMERIHEALTH PPO/PA BS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6045760 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01000584200 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 19149 . This is a "UNIVERSITY HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2183901 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3396233 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P00129818 . This is a "RR MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60002941 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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