Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | NJ |
NPI | 1023086980 |
---|---|
Provider Name | Jerome F Levine |
First Address | Hackensack, NJ 07601-1997 |
Second Address | Hackensack, NJ 07601-1997 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DO6748 | (02) | NJ |