Provider Demographics
NPI:1922281211
Name:LEVASHOV, DENNIS VLADIMIR
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:VLADIMIR
Last Name:LEVASHOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1783
Mailing Address - Country:US
Mailing Address - Phone:718-875-1505
Mailing Address - Fax:
Practice Address - Street 1:517 PARK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-1783
Practice Address - Country:US
Practice Address - Phone:718-875-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist