Provider Demographics
NPI:1346275591
Name:LEVIN, LORIN MICHELLE (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:LORIN
Middle Name:MICHELLE
Last Name:LEVIN
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:DR
Other - First Name:LORIN
Other - Middle Name:MICHELLE
Other - Last Name:GOLDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MS
Mailing Address - Street 1:76 STIRLING ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5778
Mailing Address - Country:US
Mailing Address - Phone:908-755-5437
Mailing Address - Fax:908-755-6905
Practice Address - Street 1:76 STIRLING ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5778
Practice Address - Country:US
Practice Address - Phone:908-755-5437
Practice Address - Fax:908-755-6905
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227970208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02425616Medicaid
NY02425616Medicaid