Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 152925 | NY |
NPI | 1073699195 |
---|---|
Provider Name | Mitchell E Levine |
First Address | Great Neck, NY 11021-5302 |
Second Address | Great Neck, NY 11021-5302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 18/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00751419 | (05) | NY |
C12234 | (02) | NY |