Provider Demographics
NPI:1649412180
Name:LEVITT, JANE Y (PA)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:Y
Last Name:LEVITT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:YEVGENIYA
Other - Middle Name:
Other - Last Name:LEVITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3101 OCEAN PKWY APT 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8403
Mailing Address - Country:US
Mailing Address - Phone:718-946-2481
Mailing Address - Fax:
Practice Address - Street 1:3101 OCEAN PKWY APT 1A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8403
Practice Address - Country:US
Practice Address - Phone:718-946-2481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013096-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03094819Medicaid
NYA400012567Medicare PIN