Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MA06375700 | NJ |
Y | 2080A0000X | Adolescent Medicine | MA06375700 | NJ |
NPI | 1134119811 |
---|---|
Provider Name | Dr. Bryan H Levey |
First Address | Marlton, NJ 08053-2098 |
Second Address | Marlton, NJ 08053-2098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 22/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7469608 | (05) | NJ |
G61171 | (02) |