Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 234232 | NY |
NPI | 1114017472 |
---|---|
Provider Name | Diana Levina |
First Address | Brooklyn, NY 11235-5962 |
Second Address | Brooklyn, NY 11235-6762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2006 |
Last Update Date | 08/07/2007 |