Provider Demographics
NPI:1467537860
Name:LEVINE, STEPHEN M (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13505 NW COCO PLUM CT
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-4832
Mailing Address - Country:US
Mailing Address - Phone:856-642-2133
Mailing Address - Fax:856-642-2134
Practice Address - Street 1:501 FELLOWSHIP RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3419
Practice Address - Country:US
Practice Address - Phone:856-642-2133
Practice Address - Fax:856-642-2134
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA22959207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
100017145OtherRR MEDICARE
3K6137OtherHEALTHNET
93364OtherAMERIHEALTH PPO
93364OtherPA BLUE SHIELD
NJ0343501Medicaid
1621516OtherUNITED HEALTHCARE
P3605744OtherOXFORD HEALTHPLAN
0078604000OtherAMERIHEALTH HMO, KEYSTONE , IBC
010004719OtherAMERICHOICE
0297325OtherCIGNA
1171016OtherHORIZON NJ HEALTH
20566OtherUNIVERSITY HEALTHPLAN
3056608OtherAETNA
NJ093364Medicare PIN
20566OtherUNIVERSITY HEALTHPLAN