Provider Demographics
NPI:1386680478
Name:LEVA, GINNY OLAZABAL (MD)
Entity Type:Individual
Prefix:
First Name:GINNY
Middle Name:OLAZABAL
Last Name:LEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GINNY
Other - Middle Name:
Other - Last Name:OLAZABAL LEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1501
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725
Mailing Address - Country:US
Mailing Address - Phone:631-261-0158
Mailing Address - Fax:631-261-0296
Practice Address - Street 1:320 LAUREL ROAD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768
Practice Address - Country:US
Practice Address - Phone:631-261-0158
Practice Address - Fax:631-261-0296
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173243207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY173243OtherHIP
NY2111440OtherAETNA HMO
NY54N552OtherEMPIRE BC BS OF NY
NY01068515Medicaid
NY54N551OtherEMPIRE BC BS OF NY
NY3C0048OtherHEALTHNET
NY4109440OtherAETNA PPO
NYP1131540OtherOXFORD
NY54N551OtherEMPIRE BC BS OF NY
NY3C0048OtherHEALTHNET
NY20E95ZT3Y1Medicare PIN