Provider Demographics
NPI:1932299211
Name:LEVITZKY, SUSAN ELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELLA
Last Name:LEVITZKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:161 MADISON AVE
Mailing Address - Street 2:6 WEST
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5421
Mailing Address - Country:US
Mailing Address - Phone:212-213-1960
Mailing Address - Fax:212-213-5809
Practice Address - Street 1:161 MADISON AVE
Practice Address - Street 2:6 WEST
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5421
Practice Address - Country:US
Practice Address - Phone:212-213-1960
Practice Address - Fax:212-213-5809
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY103258208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB16064Medicare UPIN