Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 25MA05941700 | NJ |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 25MA0941700 | NJ |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 25MA05941700 | NJ |
NPI | 1629045455 |
---|---|
Provider Name | Dr. Kenneth A. Levitsky |
First Address | Fair Lawn, NJ 07410-3913 |
Second Address | Fair Lawn, NJ 07410-3913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 02/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5596408 | (05) | NJ |
E20173 | (02) | NJ |