Provider Demographics
NPI:1235165747
Name:LEVITT, SELWYN B (MD)
Entity Type:Individual
Prefix:DR
First Name:SELWYN
Middle Name:B
Last Name:LEVITT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1999 MARCUS AVE
Mailing Address - Street 2:SUITE M18
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1013
Mailing Address - Country:US
Mailing Address - Phone:516-466-6953
Mailing Address - Fax:516-466-5608
Practice Address - Street 1:334 UNDERHILL AVE
Practice Address - Street 2:BUILDING 3C
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4530
Practice Address - Country:US
Practice Address - Phone:914-962-8290
Practice Address - Fax:914-962-8851
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY954921208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00158512Medicaid
NYC10973Medicare UPIN
NY528941Medicare ID - Type Unspecified