Provider Demographics
NPI:1760469142
Name:TAYTS, LEV (DO)
Entity Type:Individual
Prefix:
First Name:LEV
Middle Name:
Last Name:TAYTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 RAY FERRERO JR BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1013
Mailing Address - Country:US
Mailing Address - Phone:914-661-9359
Mailing Address - Fax:
Practice Address - Street 1:3100 RAY FERRERO JR BLVD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-1013
Practice Address - Country:US
Practice Address - Phone:914-661-9359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208197207Q00000X
FLOS19282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02189031Medicaid
G83809Medicare UPIN
NY02189031Medicaid
NY08V941Medicare ID - Type Unspecified