Provider Demographics
NPI:1578740528
Name:LEV, DMITRY
Entity Type:Individual
Prefix:MR
First Name:DMITRY
Middle Name:
Last Name:LEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 BEVERLEY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3914
Mailing Address - Country:US
Mailing Address - Phone:718-854-7622
Mailing Address - Fax:718-854-7650
Practice Address - Street 1:122 BEVERLEY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3914
Practice Address - Country:US
Practice Address - Phone:718-854-7622
Practice Address - Fax:718-854-7650
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies