Provider Demographics
NPI:1962442863
Name:LEVINE, CHAIM SIMCHA (MD)
Entity Type:Individual
Prefix:
First Name:CHAIM
Middle Name:SIMCHA
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 1:4802 TENTH AVENUE
Mailing Address - Street 2:ATTN CARDIOLOGY
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2916
Mailing Address - Country:US
Mailing Address - Phone:718-283-7489
Mailing Address - Fax:718-283-8956
Practice Address - Street 1:4802 TENTH AVENUE
Practice Address - Street 2:ATTN CARDIOLOGY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2916
Practice Address - Country:US
Practice Address - Phone:718-283-7489
Practice Address - Fax:718-283-8956
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1963371207RC0000X
NY1693371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01850999Medicaid
NY01850999Medicaid
E94662Medicare UPIN