Provider Demographics
NPI:1982249959
Name:LEVINE, CHANA DEVORA (PA-C)
Entity Type:Individual
Prefix:
First Name:CHANA
Middle Name:DEVORA
Last Name:LEVINE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14449 72ND RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2405
Mailing Address - Country:US
Mailing Address - Phone:301-908-3388
Mailing Address - Fax:
Practice Address - Street 1:14449 72ND RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2405
Practice Address - Country:US
Practice Address - Phone:301-908-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024523363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY024523OtherNEW YORK STATE