Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 199570 | NY |
NPI | 1134188352 |
---|---|
Provider Name | Dr. Sean Levchuck |
First Address | Roslyn, NY 11576-1353 |
Second Address | Roslyn, NY 11576-1353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2006 |
Last Update Date | 01/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G19061 | (02) | NY |