Provider Demographics
NPI:1750369393
Name:LEVY, PAMELA G (DC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:G
Last Name:LEVY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ROUTE 520
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8297
Mailing Address - Country:US
Mailing Address - Phone:732-617-7700
Mailing Address - Fax:732-617-7005
Practice Address - Street 1:14 ROUTE 520
Practice Address - Street 2:
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8297
Practice Address - Country:US
Practice Address - Phone:732-617-7700
Practice Address - Fax:732-617-7005
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ-MC3764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLE792225Medicare ID - Type Unspecified
NJU16599Medicare UPIN