Provider Demographics
NPI:1710074893
Name:LEVY, CAROL JOAN (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JOAN
Last Name:LEVY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1 GUSTAVE L.LEVY PLACE
Mailing Address - Street 2:3000
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-241-7975
Mailing Address - Fax:212-423-0508
Practice Address - Street 1:5 E 98TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-3422
Practice Address - Fax:212-423-0508
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199046207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01586277Medicaid
NY01586277Medicaid
NYF33453Medicare UPIN