Provider Demographics
NPI:1659740686
Name:LEVY, MIRIAM SUE
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:SUE
Last Name:LEVY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MIRIAM
Other - Middle Name:SUE
Other - Last Name:KUSHNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:23 AVON RD
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-1420
Mailing Address - Country:US
Mailing Address - Phone:914-374-1479
Mailing Address - Fax:
Practice Address - Street 1:700 WHITE PLAINS RD
Practice Address - Street 2:SUITE 343
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5063
Practice Address - Country:US
Practice Address - Phone:914-725-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177774-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology