Provider Demographics
NPI:1235217332
Name:LEVY, PAUL JUSTIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JUSTIN
Last Name:LEVY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:J
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM PLLC
Mailing Address - Street 1:2539 FISH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469
Mailing Address - Country:US
Mailing Address - Phone:718-231-2500
Mailing Address - Fax:718-231-3159
Practice Address - Street 1:2545 WALLACE AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-231-2500
Practice Address - Fax:718-231-3159
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0035811213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00791915Medicaid
P37641Medicare ID - Type Unspecified
T51147Medicare UPIN