Provider Demographics
NPI:1437325990
Name:ARKADY LEVITAN, MD
Entity Type:Organization
Organization Name:ARKADY LEVITAN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARKADY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-376-2625
Mailing Address - Street 1:PO BOX 297156
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-7156
Mailing Address - Country:US
Mailing Address - Phone:718-376-2625
Mailing Address - Fax:718-336-5291
Practice Address - Street 1:2925 W 5TH ST
Practice Address - Street 2:SUITE 52
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-3962
Practice Address - Country:US
Practice Address - Phone:718-333-0015
Practice Address - Fax:718-373-7583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216308261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02195742Medicaid
NY02195742Medicaid