Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 12176 | NJ |
NPI | 1053530840 |
---|---|
Provider Name | Dr. Wayne I. Levine |
First Address | Warren, NJ 07059-2639 |
Second Address | Warren, NJ 07059-2639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |