Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D38491 | NY |
NPI | 1003825779 |
---|---|
Provider Name | Richard Steven Levine |
First Address | Jackson Hts, NY 11372-2021 |
Second Address | Jackson Hts, NY 11372-2021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00857236 | (05) | NY |