Provider Demographics
NPI:1497950018
Name:LEV TAYTS PHYSICIAN PC
Entity Type:Organization
Organization Name:LEV TAYTS PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEV
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-324-2700
Mailing Address - Street 1:56 MARTHA PL
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-3109
Mailing Address - Country:US
Mailing Address - Phone:718-324-2700
Mailing Address - Fax:
Practice Address - Street 1:2542 BOSTON RD STE C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-9004
Practice Address - Country:US
Practice Address - Phone:718-324-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02189031Medicaid
NY02189031Medicaid
NY08V941Medicare ID - Type Unspecified