Provider Demographics
NPI:1679581631
Name:LEVY, ADRIENNE SARA (MD)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:SARA
Last Name:LEVY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 WEST JERICHO TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-864-7100
Mailing Address - Fax:631-864-7129
Practice Address - Street 1:989 WEST JERICHO TURNPIKE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-864-7100
Practice Address - Fax:631-864-7129
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1638871207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01099081Medicaid
NY050050687OtherMEDICARE RR
NY23E581Medicare ID - Type Unspecified
NY01099081Medicaid
NYAL023E5810Medicare PIN