Provider Demographics
NPI:1578659835
Name:LEVENTER, DAVID B (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:LEVENTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-0118
Mailing Address - Country:US
Mailing Address - Phone:732-571-3937
Mailing Address - Fax:732-571-1199
Practice Address - Street 1:551 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-3330
Practice Address - Country:US
Practice Address - Phone:732-571-3937
Practice Address - Fax:732-571-1199
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA72539207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8538409Medicaid
NJ049702DAFMedicare ID - Type Unspecified
NJH05003Medicare UPIN