Provider Demographics
NPI:1275746208
Name:LEVITAN, JUDY SHARON (MS)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:SHARON
Last Name:LEVITAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HOOVER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2318
Mailing Address - Country:US
Mailing Address - Phone:973-243-8698
Mailing Address - Fax:
Practice Address - Street 1:200 SOUTH ORANGE AVENUE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-322-7101
Practice Address - Fax:973-322-7124
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYA000442231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist