Provider Demographics
NPI:1710439450
Name:JONATHAN B LEVYN, DO-PC
Entity Type:Organization
Organization Name:JONATHAN B LEVYN, DO-PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEVYN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-634-5481
Mailing Address - Street 1:3402 F ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-1225
Mailing Address - Country:US
Mailing Address - Phone:215-634-5481
Mailing Address - Fax:
Practice Address - Street 1:3402 F ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1225
Practice Address - Country:US
Practice Address - Phone:215-634-5481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003971363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001089629-0001Medicaid
PAC31433Medicare UPIN