Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 094829 | NY |
NPI | 1881605160 |
---|---|
Provider Name | Dr. Gerald Harvey Leventhal |
First Address | New York, NY 10028-0913 |
Second Address | New York, NY 10028-0913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B15123 | (02) | NY |