Provider Demographics
NPI:1003912999
Name:LEVIN, BERNARD (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:LEVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 BROADWAY
Mailing Address - Street 2:APT 33 A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5005
Mailing Address - Country:US
Mailing Address - Phone:646-438-9530
Mailing Address - Fax:
Practice Address - Street 1:2628 BROADWAY
Practice Address - Street 2:APT 33 A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5005
Practice Address - Country:US
Practice Address - Phone:646-438-9530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246576207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD36672601Medicaid
800810Medicare ID - Type Unspecified
SD36672601Medicaid