Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | MA07891100 | NJ |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | MA07891100 | NJ |
NPI | 1356335558 |
---|---|
Provider Name | Dr. Jonathan Marc Levine |
First Address | Riverdale, NJ 07457-1625 |
Second Address | Riverdale, NJ 07457-1625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2005 |
Last Update Date | 01/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I33539 | (02) | NJ |