Provider Demographics
NPI:1073836169
Name:RONALD S LEVANDUSKY MD PC
Entity Type:Organization
Organization Name:RONALD S LEVANDUSKY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:LEVANDUSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-889-6999
Mailing Address - Street 1:2 5TH AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8856
Mailing Address - Country:US
Mailing Address - Phone:212-889-6999
Mailing Address - Fax:212-473-7856
Practice Address - Street 1:2 5TH AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8856
Practice Address - Country:US
Practice Address - Phone:212-889-6999
Practice Address - Fax:212-473-7856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111867-1208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00331700Medicaid
NY00331700Medicaid