Provider Demographics
NPI:1013122498
Name:LEVINE, RAPHAEL K (MD)
Entity Type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:K
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:354 OLD HOOK ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-666-3241
Mailing Address - Fax:201-666-6876
Practice Address - Street 1:354 OLD HOOK ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-666-3241
Practice Address - Fax:201-666-6876
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA 28536207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ86496793BMedicaid
NJ86496793BMedicaid
NJLE129391Medicare ID - Type Unspecified