Provider Demographics
NPI:1407163744
Name:LEVINE, ALICE RUTH (OTR)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:RUTH
Last Name:LEVINE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PHYLLIS LN
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2718
Mailing Address - Country:US
Mailing Address - Phone:631-736-1201
Mailing Address - Fax:
Practice Address - Street 1:3 PHYLLIS LN
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2718
Practice Address - Country:US
Practice Address - Phone:631-736-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000535-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor