Provider Demographics
NPI:1760408678
Name:LEVINE, STEWART ALAN (MD)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:ALAN
Last Name:LEVINE
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 1:2634 BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2539
Mailing Address - Country:US
Mailing Address - Phone:718-428-2020
Mailing Address - Fax:718-279-8077
Practice Address - Street 1:2634 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2539
Practice Address - Country:US
Practice Address - Phone:718-428-2020
Practice Address - Fax:718-279-8077
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131125207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00570232Medicaid
NY45Z862OtherMEDICARE - EMPIRE
NY49A04OtherBLUE CROSS/BLUE SHIELD
NY31341Medicare ID - Type UnspecifiedGHI MEDICARE
NY0901340001Medicare NSC
NY45Z862OtherMEDICARE - EMPIRE