Provider Demographics
NPI:1093750267
Name:LEVIN, ALLAN A (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:A
Last Name:LEVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11120 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6303
Mailing Address - Country:US
Mailing Address - Phone:718-830-0707
Mailing Address - Fax:718-544-4240
Practice Address - Street 1:11120 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6303
Practice Address - Country:US
Practice Address - Phone:718-830-0707
Practice Address - Fax:718-544-4240
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135513207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06861HMedicare ID - Type UnspecifiedGHI
NYB16294Medicare UPIN
NY06861HMedicare PIN