Provider Demographics
NPI:1437286648
Name:LEVITZ, MARY (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:LEVITZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 COUNTY ROUTE 47, PO BOX 471
Mailing Address - Street 2:SARANAC LAKE HEALTH CENTER
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-5403
Mailing Address - Country:US
Mailing Address - Phone:518-897-2850
Mailing Address - Fax:518-897-2605
Practice Address - Street 1:285 COUNTY ROUTE 47
Practice Address - Street 2:SARANAC LAKE HEALTH CENTER
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5403
Practice Address - Country:US
Practice Address - Phone:518-897-2850
Practice Address - Fax:518-897-2605
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330536-1363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYML0145323OtherDEA
NYML0145323OtherDEA
NY141731786OtherTAX ID NUMBER
NYML0145323OtherDEA
NY70138AMedicare ID - Type UnspecifiedMEDICARE B GROUP NUMBER
NYS53115Medicare PIN