Provider Demographics
NPI:1093377327
Name:LEVENSON, IVAN KARL (OCCUPATIONAL THERAPY)
Entity Type:Individual
Prefix:MR
First Name:IVAN
Middle Name:KARL
Last Name:LEVENSON
Suffix:
Gender:M
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TEEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-0001
Mailing Address - Country:US
Mailing Address - Phone:631-874-3032
Mailing Address - Fax:631-874-4105
Practice Address - Street 1:SUNRISE OF LYNBROOK
Practice Address - Street 2:53 FRANKLING AVE
Practice Address - City:N LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563
Practice Address - Country:US
Practice Address - Phone:631-874-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist