Provider Demographics
NPI:1609199157
Name:JODY LEVY MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JODY LEVY MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:DRU
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-705-1958
Mailing Address - Street 1:18370 BURBANK BLVD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2823
Mailing Address - Country:US
Mailing Address - Phone:818-705-1995
Mailing Address - Fax:
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:SUITE 701
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2823
Practice Address - Country:US
Practice Address - Phone:818-705-1995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty