Provider Demographics
NPI:1144390766
Name:DOCTORS OF NORTHPORT PRIMARY MEDICAL CARE, P.C.
Entity Type:Organization
Organization Name:DOCTORS OF NORTHPORT PRIMARY MEDICAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-699-9737
Mailing Address - Street 1:PO BOX 1501
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-0939
Mailing Address - Country:US
Mailing Address - Phone:718-699-9737
Mailing Address - Fax:718-699-4361
Practice Address - Street 1:9406 59TH AVE
Practice Address - Street 2:SUITE E9
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5151
Practice Address - Country:US
Practice Address - Phone:718-699-9737
Practice Address - Fax:718-699-4361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173118174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCG6264OtherELMHURST RR MCR GROUP#
NY5367752OtherAETNA PPO GROUP#
NY2098944OtherAETNA HMO#
NYCG6265OtherRR MEDICARE NORTHPORT GRP
NY5367752OtherAETNA PPO GROUP#
NYCG6265OtherRR MEDICARE NORTHPORT GRP