Provider Demographics
NPI:1730136664
Name:LEVANO, MARK GERALD (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:GERALD
Last Name:LEVANO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:GERALD
Other - Last Name:LEVANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:112 HAYPATH RD
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-1427
Mailing Address - Country:US
Mailing Address - Phone:516-433-7168
Mailing Address - Fax:516-938-5773
Practice Address - Street 1:112 HAYPATH RD
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-1427
Practice Address - Country:US
Practice Address - Phone:516-433-7168
Practice Address - Fax:516-938-5773
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004033-2111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT52695Medicare UPIN