Provider Demographics
NPI:1982627808
Name:LEVINE, JOSHUA LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:LOUIS
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSHUA
Other - Middle Name:L
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1601 HWY 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:212-245-8140
Mailing Address - Fax:212-245-8157
Practice Address - Street 1:57 W 57TH ST STE 1603
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2828
Practice Address - Country:US
Practice Address - Phone:212-245-8140
Practice Address - Fax:212-245-8157
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0457022086S0122X
LA15239R2086S0122X
NY2086422086S0122X
SCMD283762086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020766405OtherTAX ID NY
NJ462508521OtherTAX ID NJ
LA1063533Medicaid