Provider Demographics
NPI:1134149768
Name:LEVINSON, MARJORIE (MD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:LEVINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W 57TH ST
Mailing Address - Street 2:APT 11R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1063
Mailing Address - Country:US
Mailing Address - Phone:917-880-9303
Mailing Address - Fax:
Practice Address - Street 1:601 W 57TH ST
Practice Address - Street 2:APT 11R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1063
Practice Address - Country:US
Practice Address - Phone:917-880-9303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2048782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02706196Medicaid
NYI47674Medicare UPIN
NY02706196Medicaid