Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N0041131 | NY |
Y | 222Z00000X | Podiatrist | N0041131 | NY |
N | 213ES0131X | Foot Surgery | MD001821 | NJ |
N | 213ES0131X | Foot Surgery | N0041131 | NY |
NPI | 1366473845 |
---|---|
Provider Name | Dr. Jay Gary Levine |
First Address | Nanuet, NY 10954-2452 |
Second Address | Nanuet, NY 10954-2452 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 17/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4483320001 | DMERC (01) | |
T51444 | (02) |