Provider Demographics
NPI:1013040328
Name:LEVINGER, STANLEY IRA (OD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:IRA
Last Name:LEVINGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502B CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1713
Mailing Address - Country:US
Mailing Address - Phone:201-836-5644
Mailing Address - Fax:201-836-5699
Practice Address - Street 1:502B CEDAR LN
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1713
Practice Address - Country:US
Practice Address - Phone:201-836-5644
Practice Address - Fax:201-836-5699
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00359700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2704307Medicaid
NJT77696Medicare UPIN
NJ2704307Medicaid
NJ521743Medicare ID - Type Unspecified