Provider Demographics
NPI:1144389537
Name:LEVA, ERNEST
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:LEVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ROUTE 73 N BLDG 10, SUITE 320
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-872-7055
Mailing Address - Fax:
Practice Address - Street 1:85 BRIDGE PLAZA DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-1700
Practice Address - Country:US
Practice Address - Phone:732-972-1117
Practice Address - Fax:732-972-0177
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0533182080P0204X
NJ25MA05331800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1340000Medicaid
NJ568702CDGMedicare PIN
NJE27323Medicare UPIN
NJ234925A0ZMedicare PIN