Provider Demographics
NPI:1962826099
Name:LEVINE, FALLON (PT)
Entity Type:Individual
Prefix:
First Name:FALLON
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 E 33RD ST
Mailing Address - Street 2:APT 4D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9474
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:377 E 33RD ST
Practice Address - Street 2:APT 4D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9474
Practice Address - Country:US
Practice Address - Phone:516-234-9828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62029486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400126328Medicare PIN