Provider Demographics
NPI:1508862087
Name:LEVENTHAL, NATHAN ARTHUR (REEGT, CNIM)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:ARTHUR
Last Name:LEVENTHAL
Suffix:
Gender:M
Credentials:REEGT, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HIGHLAND PARK VLG STE 100-225
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-2789
Mailing Address - Country:US
Mailing Address - Phone:214-460-2946
Mailing Address - Fax:214-975-1312
Practice Address - Street 1:25 HIGHLAND PARK VLG STE 100-225
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-2789
Practice Address - Country:US
Practice Address - Phone:214-460-2946
Practice Address - Fax:214-975-1312
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1445246ZE0500X
TX546246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1445OtherR-EEG-T
TX546OtherCNIM