Provider Demographics
NPI:1841365376
Name:LEVINE, MORTON W (PHYSICIAN)
Entity type:Individual
Prefix:DR
First Name:MORTON
Middle Name:W
Last Name:LEVINE
Suffix:
Gender:M
Credentials:PHYSICIAN
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Mailing Address - Street 1:1821 SCHENECTADY AVE
Mailing Address - Street 2:DR MORTON W LEVINE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:718-377-8430
Mailing Address - Fax:718-251-3600
Practice Address - Street 1:1821 SCHENECTADY AVE
Practice Address - Street 2:DR MORTON W LEVINE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234
Practice Address - Country:US
Practice Address - Phone:718-377-8430
Practice Address - Fax:718-251-3600
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0873651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0873651OtherLICENSE
NY00240973Medicaid
NY00240973Medicaid
NY00240973Medicaid
NYAL0768361OtherDEA#