Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 25MA08795100 | NJ |
N | 207YS0123X | Facial Plastic Surgeon | 251990 | NY |
Y | 207YS0123X | Facial Plastic Surgeon | 25MA08795100 | NJ |
NPI | 1508073321 |
---|---|
Provider Name | Dr. Douglas Drew Leventhal |
First Address | Tarrytown, NY 10591-5139 |
Second Address | Oradell, NJ 07649-1524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 24/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25MA08795100 | LICENSE (01) | NJ |