Provider Demographics
NPI: | 1750458444 |
---|---|
Name: | LEVENE, ERIC J (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ERIC |
Middle Name: | J |
Last Name: | LEVENE |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 15 N BROADWAY |
Mailing Address - Street 2: | SUITE F |
Mailing Address - City: | WHITE PLAINS |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10601-2214 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 914-948-4422 |
Mailing Address - Fax: | 914-948-9536 |
Practice Address - Street 1: | 15 N BROADWAY |
Practice Address - Street 2: | SUITE F |
Practice Address - City: | WHITE PLAINS |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10601-2214 |
Practice Address - Country: | US |
Practice Address - Phone: | 914-948-4422 |
Practice Address - Fax: | 914-948-9536 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-11-29 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 188161 | 208000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 000000087267 | Other | GHI HMO |
NY | 2695674 | Other | GHI PPO |
NY | WP435 | Other | OXFORD HEALTH PLANS |
NY | WP0066 | Other | HEALTHNET |
NY | 6411958 | Other | CIGNA |
NY | 4348856 | Other | AETNA |
NY | WP0066 | Other | HEALTHNET |