Provider Demographics
NPI:1376646331
Name:LEVY, JAY RICHARD (DPM)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:RICHARD
Last Name:LEVY
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 1:120 E WASHINGTON ST STE 308
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-4007
Mailing Address - Country:US
Mailing Address - Phone:315-422-0453
Mailing Address - Fax:315-638-2034
Practice Address - Street 1:120 E WASHINGTON ST
Practice Address - Street 2:STE 308
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-4007
Practice Address - Country:US
Practice Address - Phone:315-422-0453
Practice Address - Fax:315-638-2034
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0023131213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02662673Medicaid
C32925BOtherFIRST UNITED AMERICAN LIF
P3026OtherEMPIRE BC
P3026OtherEMPIRE BC
NY02662673Medicaid
NY32925BMedicare PIN