Provider Demographics
NPI:1609849546
Name:PUKIN, LEV (MD)
Entity Type:Individual
Prefix:DR
First Name:LEV
Middle Name:
Last Name:PUKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3049 OCEAN PKWY STE 303
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8367
Mailing Address - Country:US
Mailing Address - Phone:718-737-7200
Mailing Address - Fax:888-960-2493
Practice Address - Street 1:3049 OCEAN PKWY STE 303
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8367
Practice Address - Country:US
Practice Address - Phone:718-737-7200
Practice Address - Fax:888-960-2493
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2244602085R0204X
NJ25MA075063002085R0202X, 2085R0204X
FL751792085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8863300Medicaid
NJ8863300Medicaid
NJP00086186Medicare PIN
NJH63009Medicare UPIN