Provider Demographics
NPI:1942684733
Name:LEVITSKI, MAXIM
Entity Type:Individual
Prefix:
First Name:MAXIM
Middle Name:
Last Name:LEVITSKI
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 1:10 SHORE BLVD
Mailing Address - Street 2:APT. 3M
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4056
Mailing Address - Country:US
Mailing Address - Phone:347-772-5888
Mailing Address - Fax:
Practice Address - Street 1:10 SHORE BLVD
Practice Address - Street 2:APT. 3M
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4056
Practice Address - Country:US
Practice Address - Phone:347-772-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1285001174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist