Provider Demographics
NPI:1760437834
Name:LEVINSON, PAUL S (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:LEVINSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 RT 23 SOUTH
Mailing Address - Street 2:PO BOX 733
Mailing Address - City:NEWFOUNDLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07435
Mailing Address - Country:US
Mailing Address - Phone:973-697-8100
Mailing Address - Fax:973-697-8104
Practice Address - Street 1:2713 RT 23 SOUTH
Practice Address - Street 2:
Practice Address - City:NEWFOUNDLAND
Practice Address - State:NJ
Practice Address - Zip Code:07435
Practice Address - Country:US
Practice Address - Phone:973-697-8100
Practice Address - Fax:973-697-8104
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA004235152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ047630701Medicaid
T88962Medicare UPIN
NJ047630701Medicaid