Provider Demographics
NPI:1780629204
Name:HEALTHCARE MEDICAL PC
Entity Type:Organization
Organization Name:HEALTHCARE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-375-4747
Mailing Address - Street 1:49 WEED AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4922
Mailing Address - Country:US
Mailing Address - Phone:718-375-4747
Mailing Address - Fax:718-375-2333
Practice Address - Street 1:1749 E 16TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2931
Practice Address - Country:US
Practice Address - Phone:719-375-4747
Practice Address - Fax:718-375-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02594076Medicaid
NY02594076Medicaid