Provider Demographics
NPI:1962500363
Name:MARJORIE LEVITAN MD PC
Entity Type:Organization
Organization Name:MARJORIE LEVITAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:LEVITAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-316-4060
Mailing Address - Street 1:PO BOX 20046
Mailing Address - Street 2:PARK WEST STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-316-4060
Mailing Address - Fax:212-316-4062
Practice Address - Street 1:1090 AMSTERDAM AVE
Practice Address - Street 2:SUITE 8A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025
Practice Address - Country:US
Practice Address - Phone:212-376-4060
Practice Address - Fax:212-316-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01722903Medicaid
NY184468POtherHIP OF NEW YORK
NYP2350461OtherOXFORD
005AR2OtherEMPIRE BCBS
NYP2350461OtherOXFORD
NY01722903Medicaid