Provider Demographics
NPI:1043217987
Name:LEVITT, MARC STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:STEVEN
Last Name:LEVITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:135 PARK BLVD
Mailing Address - Street 2:P. O. BOX 308
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3643
Mailing Address - Country:US
Mailing Address - Phone:516-795-9090
Mailing Address - Fax:516-795-6478
Practice Address - Street 1:135 PARK BLVD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-3643
Practice Address - Country:US
Practice Address - Phone:516-795-9090
Practice Address - Fax:516-795-6478
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY141701207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00743453Medicaid
NY00743453Medicaid
NYB-79490Medicare UPIN