Provider Demographics
NPI:1245287986
Name:ELLIOT M LEVINE, MD PLLC
Entity type:Organization
Organization Name:ELLIOT M LEVINE, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-297-6450
Mailing Address - Street 1:66 MIDDLEBUSH RD
Mailing Address - Street 2:SUITE U-306
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4098
Mailing Address - Country:US
Mailing Address - Phone:845-297-6450
Mailing Address - Fax:845-297-6160
Practice Address - Street 1:66 MIDDLEBUSH RD
Practice Address - Street 2:SUITE U-306
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4098
Practice Address - Country:US
Practice Address - Phone:845-297-6450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201852207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID#
NY=========OtherTAX ID#