Provider Demographics
NPI:1922248962
Name:LEVI, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LEVI
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 1:72 W JIMMIE LEEDS RD
Mailing Address - Street 2:STE 1100
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9406
Mailing Address - Country:US
Mailing Address - Phone:609-677-9729
Mailing Address - Fax:
Practice Address - Street 1:72 W JIMMIE LEEDS RD
Practice Address - Street 2:STE 1100
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9406
Practice Address - Country:US
Practice Address - Phone:609-677-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA087385002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00884990OtherRR MEDICARE
NJP00884973OtherRR MEDICARE
NJ8231907Medicaid
NJP00884989OtherRR MEDICARE
194378ZDDPMedicare PIN
NJ8231907Medicaid
194378ZEKDMedicare PIN