Provider Demographics
NPI:1952615247
Name:ELLEN LEVAN, MD, PC
Entity Type:Organization
Organization Name:ELLEN LEVAN, MD, PC
Other - Org Name:BRANFORD MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-424-0080
Mailing Address - Street 1:23 BRANFORD PL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2711
Mailing Address - Country:US
Mailing Address - Phone:973-424-0080
Mailing Address - Fax:973-424-0088
Practice Address - Street 1:23 BRANFORD PL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2711
Practice Address - Country:US
Practice Address - Phone:973-424-0080
Practice Address - Fax:973-424-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP05605400164W00000X
NJ25MA04281900207R00000X
NJ25MA07184800207R00000X
NJ25MA055695002080P0207X
NJ25MP00016700363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8449007Medicaid
NJ7528001Medicaid
NJ045962Medicare PIN
NJ004792Medicare PIN