Provider Demographics
NPI:1750552048
Name:RICHARD LEVINE
Entity type:Organization
Organization Name:RICHARD LEVINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:TEDDY
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-261-4925
Mailing Address - Street 1:120 MADISON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2055
Mailing Address - Country:US
Mailing Address - Phone:609-261-6701
Mailing Address - Fax:609-261-9362
Practice Address - Street 1:120 MADISON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2055
Practice Address - Country:US
Practice Address - Phone:609-261-6701
Practice Address - Fax:609-261-9362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GROSSMAN LEVINE LEVINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03356800261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1689601791Medicare UPIN