Provider Demographics
NPI:1164593554
Name:LEVY, I. MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:I. MARTIN
Middle Name:
Last Name:LEVY
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 1:38 JUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-2232
Mailing Address - Country:US
Mailing Address - Phone:718-405-8430
Mailing Address - Fax:718-405-8428
Practice Address - Street 1:CENTER FOR ORTHO. SPECIALTY
Practice Address - Street 2:1695 EASTCHESTER ROAD
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-405-8430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137129207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery