Provider Demographics
NPI:1427216472
Name:DR LEVIN GOLDMANN EZRA
Entity Type:Organization
Organization Name:DR LEVIN GOLDMANN EZRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-327-6592
Mailing Address - Street 1:1301 CORNAGA AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691
Mailing Address - Country:US
Mailing Address - Phone:718-327-6592
Mailing Address - Fax:718-327-2206
Practice Address - Street 1:1229 BROADWAY
Practice Address - Street 2:SUITE 207
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557
Practice Address - Country:US
Practice Address - Phone:516-374-2215
Practice Address - Fax:516-374-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26221204E00000X
NY040873204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00281970Medicaid
NY01406275Medicaid