Provider Demographics
NPI:1083731012
Name:OLD FASHIONED MEDICINE PC
Entity Type:Organization
Organization Name:OLD FASHIONED MEDICINE PC
Other - Org Name:PETER LEVI, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-741-0515
Mailing Address - Street 1:325 MANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-2122
Mailing Address - Country:US
Mailing Address - Phone:914-741-0515
Mailing Address - Fax:845-741-0898
Practice Address - Street 1:325 MANVILLE RD
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2122
Practice Address - Country:US
Practice Address - Phone:914-741-0515
Practice Address - Fax:845-741-0898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY847651Medicare ID - Type Unspecified