Provider Demographics
NPI:1255506408
Name:BRIAN KEITH LEVY
Entity Type:Organization
Organization Name:BRIAN KEITH LEVY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-642-2088
Mailing Address - Street 1:1390 PENNSYLVANIA AVE
Mailing Address - Street 2:STE E STARRET CITY PODIATRY
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239
Mailing Address - Country:US
Mailing Address - Phone:718-642-2088
Mailing Address - Fax:718-642-2096
Practice Address - Street 1:1390 PENNSYLVANIA AVE
Practice Address - Street 2:STE E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239
Practice Address - Country:US
Practice Address - Phone:718-642-2088
Practice Address - Fax:718-642-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005753213E00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02277838Medicaid
NYBLOPG9401Medicare PIN
NY02277838Medicaid
NY4616210001Medicare NSC