Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 038975-1 | NY |
NPI | 1114141926 |
---|---|
Provider Name | Dr. Joan Beth Levine |
First Address | New York, NY 10016-9463 |
Second Address | New York, NY 10007-1001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01201812 | (05) | NY |