Provider Demographics
NPI:1043469117
Name:LEVITT, GARY ALAN (RN)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALAN
Last Name:LEVITT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1003 DOLPHIN LN
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-6209
Mailing Address - Country:US
Mailing Address - Phone:631-327-9753
Mailing Address - Fax:
Practice Address - Street 1:109 RIVIERA PKWY
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-6116
Practice Address - Country:US
Practice Address - Phone:631-412-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031276225700000X
NY533606163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist