Provider Demographics
NPI:1821081787
Name:LEVITAN, LAWRENCE JAY (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:JAY
Last Name:LEVITAN
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 1:137 E 36TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3528
Mailing Address - Country:US
Mailing Address - Phone:212-679-2223
Mailing Address - Fax:
Practice Address - Street 1:137 E 36TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3528
Practice Address - Country:US
Practice Address - Phone:212-679-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150770174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist