Provider Demographics
NPI:1215157656
Name:LEVENSON, PERRY ALAN (LAC LMT)
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:ALAN
Last Name:LEVENSON
Suffix:
Gender:M
Credentials:LAC LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MAMARONECK AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1612
Mailing Address - Country:US
Mailing Address - Phone:914-584-6995
Mailing Address - Fax:866-826-1943
Practice Address - Street 1:550 MAMARONECK AVE STE 102
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1612
Practice Address - Country:US
Practice Address - Phone:914-584-6995
Practice Address - Fax:866-826-1943
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002553-1171100000X
NY002533171100000X
NY007-090-1174400000X
NY002553171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY26-177721OtherEIN