Provider Demographics
NPI:1710105606
Name:LEVY, BETH R (PA)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:R
Last Name:LEVY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:LUSTGARTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:40 UNDERCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1510
Mailing Address - Country:US
Mailing Address - Phone:646-772-5505
Mailing Address - Fax:
Practice Address - Street 1:40 UNDERCLIFF RD
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1510
Practice Address - Country:US
Practice Address - Phone:646-772-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009040363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant