Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | N007087 | NY |
NPI | 1043664659 |
---|---|
Provider Name | Jack Levenson |
First Address | New Hyde Park, NY 11042-1214 |
Second Address | New Hyde Park, NY 11042-1214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2016 |
Last Update Date | 01/06/2020 |