Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 26NJ00414700 | NJ |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 26NJ00414700 | NJ |
NPI | 1013251685 |
---|---|
Provider Name | Jennifer Levitt |
First Address | Kendall Park, NJ 08824-1433 |
Second Address | Brick, NJ 08724-2320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2012 |
Last Update Date | 10/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22-3052989 | TAX ID # (01) | NJ |