Provider Demographics
NPI:1609315720
Name:LEVIN, KIRILL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KIRILL
Middle Name:
Last Name:LEVIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:570 EGG HARBOR RD STE B1
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080
Practice Address - Country:US
Practice Address - Phone:856-428-7700
Practice Address - Fax:856-341-8394
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA058792363AS0400X
NJ25MP00427300363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical