Provider Demographics
NPI:1710037668
Name:LEVINE, SUZANNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 PARK AVE
Mailing Address - Street 2:SUITE 103-105
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0325
Mailing Address - Country:US
Mailing Address - Phone:212-535-0229
Mailing Address - Fax:
Practice Address - Street 1:885 PARK AVE
Practice Address - Street 2:SUITE 103-105
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0325
Practice Address - Country:US
Practice Address - Phone:212-535-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002752213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT50862Medicare UPIN