Provider Demographics
NPI:1912900416
Name:LEVISON, JONATHAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
Last Name:LEVISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:433 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2520
Mailing Address - Country:US
Mailing Address - Phone:973-759-9000
Mailing Address - Fax:973-759-2487
Practice Address - Street 1:1401 BROAD ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-4236
Practice Address - Country:US
Practice Address - Phone:973-759-9000
Practice Address - Fax:973-751-3730
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO6867000174400000X
NJ25MA068670002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG87248Medicare UPIN
NJ023956A3WMedicare PIN