Provider Demographics
NPI:1760456016
Name:LEVANT, BARRY E (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:E
Last Name:LEVANT
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 KIEL AVE
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2565
Mailing Address - Country:US
Mailing Address - Phone:973-838-4098
Mailing Address - Fax:973-838-7628
Practice Address - Street 1:15 KIEL AVE
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2565
Practice Address - Country:US
Practice Address - Phone:973-838-4098
Practice Address - Fax:973-838-7628
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ33660207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7726805Medicaid
NJC55355Medicare UPIN
NJ7726805Medicaid