Provider Demographics
NPI:1952817579
Name:JOSHUA L LEVINE MD NJ PC
Entity Type:Organization
Organization Name:JOSHUA L LEVINE MD NJ PC
Other - Org Name:CENTER FOR BREAST RECONSTRUCTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-769-2557
Mailing Address - Street 1:1601 ROUTE 35 UNIT 298
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-6711
Mailing Address - Country:US
Mailing Address - Phone:732-769-2557
Mailing Address - Fax:732-361-2479
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1915
Practice Address - Country:US
Practice Address - Phone:732-769-2557
Practice Address - Fax:732-361-2479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSHUA L LEVINE MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA087118002086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty