Provider Demographics
NPI:1417903170
Name:LEVINSON, MARC A (OD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:LEVINSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076
Mailing Address - Country:US
Mailing Address - Phone:908-322-8040
Mailing Address - Fax:908-322-8995
Practice Address - Street 1:350 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076
Practice Address - Country:US
Practice Address - Phone:908-322-8040
Practice Address - Fax:908-322-8995
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA004234152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0476404Medicaid
NJ0476404Medicaid
NJ1977300001Medicare NSC
NJ521496Medicare PIN