Provider Demographics
NPI:1891868881
Name:LEVICH, SIMON (DPM)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:LEVICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:209 AVENUE P
Mailing Address - Street 2:DR S LEVICH
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:718-259-6666
Mailing Address - Fax:718-259-7000
Practice Address - Street 1:209 AVENUE P
Practice Address - Street 2:DR S LEVICH
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:718-259-6666
Practice Address - Fax:718-259-7000
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY004735213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01353566Medicaid
NYA400006616Medicare PIN