Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | MC03031 | NJ |
Y | 213ER0200X | Radiology | MC03031 | NJ |
NPI | 1760492920 |
---|---|
Provider Name | Stephen J Levine |
First Address | South Orange, NJ 07079 |
Second Address | South Orange, NJ 07079-1916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T42456 | (02) |