Provider Demographics
NPI:1659626406
Name:LEVINSON, JOAN (ED M)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:LEVINSON
Suffix:
Gender:F
Credentials:ED M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1717
Mailing Address - Country:US
Mailing Address - Phone:908-789-9212
Mailing Address - Fax:
Practice Address - Street 1:2051 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1717
Practice Address - Country:US
Practice Address - Phone:908-789-9212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist