Provider Demographics
NPI:1942375126
Name:LEVINE, MICHAEL ROSS (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROSS
Last Name:LEVINE
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 1:15 IRVING PLACE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1229
Mailing Address - Country:US
Mailing Address - Phone:516-374-6750
Mailing Address - Fax:516-374-6758
Practice Address - Street 1:15 IRVING PLACE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1229
Practice Address - Country:US
Practice Address - Phone:516-374-6750
Practice Address - Fax:516-374-6758
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A61195Medicare UPIN
NY20E731Medicare ID - Type Unspecified