Provider Demographics
NPI:1619430915
Name:LEVANDOVSKIY, BORIS (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:LEVANDOVSKIY
Suffix:
Gender:M
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 68TH ST # 99
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4870
Mailing Address - Country:US
Mailing Address - Phone:212-746-4684
Mailing Address - Fax:646-962-0148
Practice Address - Street 1:525 E 68TH ST # 99
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-4684
Practice Address - Fax:646-962-0148
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308601363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner