Provider Demographics
NPI:1114348208
Name:LEVENSON, DALE
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:LEVENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 OCEAN AVE
Mailing Address - Street 2:APT 15 J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3971
Mailing Address - Country:US
Mailing Address - Phone:732-245-8606
Mailing Address - Fax:
Practice Address - Street 1:1401 OCEAN AVE
Practice Address - Street 2:APT 15 J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3971
Practice Address - Country:US
Practice Address - Phone:732-245-8606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1278537174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist