Provider Demographics
NPI:1467669143
Name:LEVINE, JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 AVE DE LA CONSTITUCION
Mailing Address - Street 2:APTO 1002 COND MILENNIUM
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-2312
Mailing Address - Country:US
Mailing Address - Phone:516-298-2558
Mailing Address - Fax:787-977-8010
Practice Address - Street 1:550 AVE DE LA CONSTITUCION
Practice Address - Street 2:APTO 1002 COND MILENNIUM
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-2312
Practice Address - Country:US
Practice Address - Phone:516-298-2558
Practice Address - Fax:787-977-8010
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15777208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice