Provider Demographics
NPI:1134119811
Name:LEVEY, BRYAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:H
Last Name:LEVEY
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 1:475 OLD MARLTON PIKE W
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2098
Mailing Address - Country:US
Mailing Address - Phone:609-662-5437
Mailing Address - Fax:609-858-6120
Practice Address - Street 1:475 OLD MARLTON PIKE W
Practice Address - Street 2:SUITE 4
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2098
Practice Address - Country:US
Practice Address - Phone:609-662-5437
Practice Address - Fax:609-858-6120
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06375700208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7469608Medicaid
NJ7469608Medicaid