Provider Demographics
NPI:1760477012
Name:LEVINSON, KIM ALISON (CPNP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ALISON
Last Name:LEVINSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:GREENFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:33 CEDAR STREET
Mailing Address - Street 2:PO BOX 208064
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510
Mailing Address - Country:US
Mailing Address - Phone:203-785-5708
Mailing Address - Fax:203-737-2236
Practice Address - Street 1:33 CEDAR STREET
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-785-5708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3806671363LP0200X
CT6992363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01448118Medicaid
NY416051A15OtherHEALTH FIRST
NY3C8224OtherHEALTH NET
NYLK6051OtherATLANTIS HEALTH PLAN
NY11-3632852OtherPHCS
NY113632852OtherMULTIPLAN
NYP2944354OtherOXFORD HEALTH
NY1184431OtherUNITED HEALTHCARE
NY7500409OtherGHI
NY3C8224OtherHEALTH NET
NY0434G1Medicare ID - Type Unspecified