Provider Demographics
NPI:1891047254
Name:LEVENTHAL LEVIN, MARJORIE S (MSED)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:S
Last Name:LEVENTHAL LEVIN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:S
Other - Last Name:LEVENTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:23 VALLEY LN N
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3630
Mailing Address - Country:US
Mailing Address - Phone:516-791-4876
Mailing Address - Fax:516-374-1447
Practice Address - Street 1:23 VALLEY LN N
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3630
Practice Address - Country:US
Practice Address - Phone:516-791-4876
Practice Address - Fax:516-374-1447
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist