Provider Demographics
NPI:1750422754
Name:LEVITT, MARY ANN (CA)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:LEVITT
Suffix:
Gender:F
Credentials:CA
Other - Prefix:
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Mailing Address - Street 1:125 HARPER ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2133
Mailing Address - Country:US
Mailing Address - Phone:732-828-5455
Mailing Address - Fax:732-828-8990
Practice Address - Street 1:33 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2620
Practice Address - Country:US
Practice Address - Phone:732-828-5455
Practice Address - Fax:732-828-8990
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00026900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist