Provider Demographics
NPI:1346277738
Name:LEVITZ, LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:LEVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WEED AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4922
Mailing Address - Country:US
Mailing Address - Phone:718-375-4747
Mailing Address - Fax:718-375-2333
Practice Address - Street 1:1749 E 16TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2931
Practice Address - Country:US
Practice Address - Phone:718-375-4747
Practice Address - Fax:718-375-2333
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215862207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02011672Medicaid
NY797082Medicare ID - Type Unspecified
NY02011672Medicaid