Provider Demographics
NPI:1508264359
Name:DR. ANDREW B. LEVY, DDS, P.C.
Entity Type:Organization
Organization Name:DR. ANDREW B. LEVY, DDS, P.C.
Other - Org Name:VILLAGE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-674-2024
Mailing Address - Street 1:77 E. 12TH ST
Mailing Address - Street 2:PS1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-674-2024
Mailing Address - Fax:212-674-2023
Practice Address - Street 1:77 E. 12TH ST
Practice Address - Street 2:PS1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-674-2024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLAGE DENTAL (DBA)
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0562101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty