Provider Demographics
NPI:1659543098
Name:LEONARD LEVITAN
Entity Type:Organization
Organization Name:LEONARD LEVITAN
Other - Org Name:MERRICK FOOT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM FAC FAOM
Authorized Official - Phone:516-378-9100
Mailing Address - Street 1:1851 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566
Mailing Address - Country:US
Mailing Address - Phone:516-378-9100
Mailing Address - Fax:516-546-4870
Practice Address - Street 1:1851 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566
Practice Address - Country:US
Practice Address - Phone:516-378-9100
Practice Address - Fax:516-546-4870
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEONARD LEVITAN, DPM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-26
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY002166213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1294830001OtherSUPPLIER MEDICARE NO.
NY1659543098OtherDMERC ORGANIZATIONAL NPI
NY00415807Medicaid
NYT50683Medicare UPIN
NY1659543098OtherDMERC ORGANIZATIONAL NPI
NY00415807Medicaid
NYP22441Medicare PIN