Provider Demographics
NPI:1205017183
Name:BEHAVIORAL MEDICAL
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-351-8100
Mailing Address - Street 1:500 SEAVIEW AVE
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3403
Mailing Address - Country:US
Mailing Address - Phone:718-351-8100
Mailing Address - Fax:718-351-4560
Practice Address - Street 1:500 SEAVIEW AVE
Practice Address - Street 2:SUITE 200A
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3403
Practice Address - Country:US
Practice Address - Phone:718-351-8100
Practice Address - Fax:718-351-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10680511744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Single Specialty