Provider Demographics
NPI:1669529186
Name:LEVINE, JEFFREY M (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:928 BROADWAY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6008
Mailing Address - Country:US
Mailing Address - Phone:212-253-5601
Mailing Address - Fax:212-253-6602
Practice Address - Street 1:928 BROADWAY
Practice Address - Street 2:SUITE 305
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6008
Practice Address - Country:US
Practice Address - Phone:212-253-5601
Practice Address - Fax:212-253-6602
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY158288207RG0300X
NJ41410207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04482OtherGHI NUMBER
NY01126310Medicaid
NY01126310Medicaid
NY04482OtherGHI NUMBER