Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | MA33347 | NJ |
NPI | 1124175419 |
---|---|
Provider Name | Dr. Richard Levandowski |
First Address | Lawrenceville, NJ 08648-2201 |
Second Address | Lawrenceville, NJ 08648-2201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 17/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C54336 | (02) | NJ |