Provider Demographics
NPI:1851396329
Name:LEVIN, LEWIS M (MD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:M
Last Name:LEVIN
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 1:40 WINDSOR GATE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1061
Mailing Address - Country:US
Mailing Address - Phone:516-233-2917
Mailing Address - Fax:516-570-6457
Practice Address - Street 1:40 WINDSOR GATE DR
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:NY
Practice Address - Zip Code:11040-1061
Practice Address - Country:US
Practice Address - Phone:516-233-2917
Practice Address - Fax:516-570-6457
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113012207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00204797Medicaid
NYB79826Medicare UPIN
NYW6L531Medicare ID - Type Unspecified