Provider Demographics
NPI:1669465233
Name:LEVINE, ELLIOT M (MD)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:M
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 1:66 MIDDLEBUSH RD
Mailing Address - Street 2:SUITE U-306
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4098
Mailing Address - Country:US
Mailing Address - Phone:845-297-6450
Mailing Address - Fax:845-297-6160
Practice Address - Street 1:66 MIDDLEBUSH RD
Practice Address - Street 2:SUITE U-306
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4098
Practice Address - Country:US
Practice Address - Phone:845-297-6450
Practice Address - Fax:845-297-6160
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201852207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY117063OtherMVP HEALTHCARE
NY2018521OtherWORKERS COMPENSATION
NY01654466Medicaid
NYP495454OtherOXFORD
NY10031790OtherCDPHP
NY5460423OtherAETNA
NY14N011OtherEMPIRE BCBS
NY2506422OtherGHI
NY2C7584OtherHEALTHNET
NY432704NOtherCIGNA
NYP495454OtherOXFORD
NY432704NOtherCIGNA