Provider Demographics
NPI:1144394214
Name:LEVENTHAL, KEITH S (DO)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:S
Last Name:LEVENTHAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2374 JERUSALEM AVE
Mailing Address - Street 2:
Mailing Address - City:N BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1825
Mailing Address - Country:US
Mailing Address - Phone:516-409-8311
Mailing Address - Fax:516-409-8313
Practice Address - Street 1:2374 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1825
Practice Address - Country:US
Practice Address - Phone:516-409-8311
Practice Address - Fax:516-409-8313
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY208565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01937140Medicaid
NY01937140Medicaid
NY06V561Medicare ID - Type Unspecified