Provider Demographics
NPI:1033135538
Name:LEVOUNIS, PETROS (MD, MA)
Entity Type:Individual
Prefix:
First Name:PETROS
Middle Name:
Last Name:LEVOUNIS
Suffix:
Gender:M
Credentials:MD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 S ORANGE AVE
Mailing Address - Street 2:ROOM F-1436
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2757
Mailing Address - Country:US
Mailing Address - Phone:973-972-7117
Mailing Address - Fax:973-972-7804
Practice Address - Street 1:183 S ORANGE AVE
Practice Address - Street 2:ROOM F-1436
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2757
Practice Address - Country:US
Practice Address - Phone:973-972-7117
Practice Address - Fax:973-972-7804
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2068262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02330303Medicaid
NY02330303Medicaid
NY293BK1Medicare ID - Type UnspecifiedMEDICARE