Provider Demographics
NPI:1932198983
Name:LEVINE, VICKI J (MD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:J
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:635 MADISON AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1009
Mailing Address - Country:US
Mailing Address - Phone:212-588-8806
Mailing Address - Fax:212-308-6847
Practice Address - Street 1:635 MADISON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1009
Practice Address - Country:US
Practice Address - Phone:212-588-8806
Practice Address - Fax:212-308-6847
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2013-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY147719207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB14266Medicare UPIN
NY40D781Medicare PIN
NY14266Medicare UPIN