Provider Demographics
NPI:1366473845
Name:LEVINE, JAY GARY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:GARY
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 OLD NYACK TURNPIKE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2452
Mailing Address - Country:US
Mailing Address - Phone:845-623-5933
Mailing Address - Fax:845-623-4261
Practice Address - Street 1:55 OLD NYACK TURNPIKE
Practice Address - Street 2:SUITE 407
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2452
Practice Address - Country:US
Practice Address - Phone:845-623-5933
Practice Address - Fax:845-623-4261
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0041131213E00000X, 213ES0131X
NJMD001821213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4483320001OtherDMERC
T51444Medicare UPIN
4483320001OtherDMERC