Provider Demographics
NPI:1972556132
Name:JONATHAN M. LEVY, DPM, PC
Entity Type:Organization
Organization Name:JONATHAN M. LEVY, DPM, PC
Other - Org Name:PARK 56 PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-980-6487
Mailing Address - Street 1:120 E 56TH ST
Mailing Address - Street 2:SUITE 940
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3607
Mailing Address - Country:US
Mailing Address - Phone:212-980-6487
Mailing Address - Fax:212-980-8685
Practice Address - Street 1:120 E 56TH ST
Practice Address - Street 2:SUITE 940
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3607
Practice Address - Country:US
Practice Address - Phone:212-980-6487
Practice Address - Fax:212-980-8685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003732213E00000X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Single Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00877436Medicaid
NYP00345607OtherRAILROAD MEDICARE
NY6251590001Medicare NSC
NYPBWH61Medicare ID - Type UnspecifiedGROUP MEDICARE ID#
NY00877436Medicaid