Provider Demographics
NPI:1023017316
Name:LEVINE, MALCOLM E (MD)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:E
Last Name:LEVINE
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 1:1201 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3001
Mailing Address - Country:US
Mailing Address - Phone:516-627-1221
Mailing Address - Fax:516-627-6857
Practice Address - Street 1:1201 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3001
Practice Address - Country:US
Practice Address - Phone:516-627-1221
Practice Address - Fax:516-627-6857
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093658207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400000986Medicare PIN
110130530Medicare PIN
NYC09888Medicare UPIN
NY4371832441Medicare PIN