Provider Demographics
NPI:1073699195
Name:LEVINE, MITCHELL E (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:E
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 NORTHERN BLVD
Mailing Address - Street 2:STE 260
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5302
Mailing Address - Country:US
Mailing Address - Phone:516-773-7737
Mailing Address - Fax:516-773-7751
Practice Address - Street 1:900 NORTHERN BLVD
Practice Address - Street 2:SSTE 260
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5302
Practice Address - Country:US
Practice Address - Phone:516-773-7737
Practice Address - Fax:516-773-7751
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2012-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY152925207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00751419Medicaid
NY85A60ANM72Medicare PIN
NY00751419Medicaid