Provider Demographics
NPI:1598068124
Name:LEVINE, SUSAN J (CPNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:LEVINE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:165 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-4702
Mailing Address - Country:US
Mailing Address - Phone:914-941-1263
Mailing Address - Fax:914-914-0993
Practice Address - Street 1:132 RECTORY ST
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-3240
Practice Address - Country:US
Practice Address - Phone:914-939-1205
Practice Address - Fax:914-939-1187
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF382105-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03309304Medicaid