Provider Demographics
NPI:1518096692
Name:LEVINE, RICHARD EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EVAN
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:663 PALISADE AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3012
Mailing Address - Country:US
Mailing Address - Phone:201-941-9400
Mailing Address - Fax:201-941-5840
Practice Address - Street 1:663 PALISADE AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3012
Practice Address - Country:US
Practice Address - Phone:201-941-9400
Practice Address - Fax:201-941-5840
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05042700207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ043749519OtherTAX ID
NJE60228Medicare UPIN