Provider Demographics
NPI:1437120714
Name:LEVY, RICHARD
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:LEVY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LATHAM CIR
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-4213
Mailing Address - Country:US
Mailing Address - Phone:845-247-3227
Mailing Address - Fax:
Practice Address - Street 1:1 NORTHWAY LN
Practice Address - Street 2:SUITE 1
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4815
Practice Address - Country:US
Practice Address - Phone:518-786-1291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1785702085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02743864Medicaid
NYA400105845Medicare PIN
F22546Medicare UPIN