Provider Demographics
NPI:1629014840
Name:LEVINE, CARY L (MD)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:L
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 E. SUNRISE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2518
Mailing Address - Country:US
Mailing Address - Phone:631-884-1188
Mailing Address - Fax:631-884-1107
Practice Address - Street 1:291 E SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2518
Practice Address - Country:US
Practice Address - Phone:631-884-1188
Practice Address - Fax:631-884-1107
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128655207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCL03181310Medicare ID - Type Unspecified
NYC-08344Medicare UPIN