Provider Demographics
NPI:1346905767
Name:LEVINE, JENNIFER JILL (LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JILL
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 8TH AVE BSMT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4142
Mailing Address - Country:US
Mailing Address - Phone:718-415-0738
Mailing Address - Fax:718-228-0833
Practice Address - Street 1:816 8TH AVE BSMT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4142
Practice Address - Country:US
Practice Address - Phone:718-415-0738
Practice Address - Fax:718-228-8033
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006866171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty