Provider Demographics
NPI:1093980658
Name:LEVITTOWN CLINICAL CENTER PSC
Entity Type:Organization
Organization Name:LEVITTOWN CLINICAL CENTER PSC
Other - Org Name:LEVITTOWN MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ-SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD-HCM, MS
Authorized Official - Phone:787-998-7462
Mailing Address - Street 1:PO BOX 1784
Mailing Address - Street 2:
Mailing Address - City:SABANA SECA
Mailing Address - State:PR
Mailing Address - Zip Code:00952-1784
Mailing Address - Country:US
Mailing Address - Phone:787-998-7462
Mailing Address - Fax:787-998-7542
Practice Address - Street 1:AVE LOS DOMINICOS RH 8
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-998-7462
Practice Address - Fax:787-998-7542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty