Provider Demographics
NPI:1851473748
Name:LEVINE, JAY L (DC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:L
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 HARRY L DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1402
Mailing Address - Country:US
Mailing Address - Phone:607-797-7990
Mailing Address - Fax:607-797-2230
Practice Address - Street 1:341 HARRY L DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1402
Practice Address - Country:US
Practice Address - Phone:607-797-7990
Practice Address - Fax:607-797-2230
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY40347OtherWORKERS' COMPENSATION
NY5510685OtherAETNA
NYDC02335NLEOtherGROUP
NYDC02335NLEOtherGROUP