Provider Demographics
NPI:1982788188
Name:LEVINE, DONALD TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:TODD
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 CORPORATE WAY STE 2M
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2027
Mailing Address - Country:US
Mailing Address - Phone:718-907-2889
Mailing Address - Fax:718-414-1651
Practice Address - Street 1:75 N BROADWAY
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2624
Practice Address - Country:US
Practice Address - Phone:845-358-1700
Practice Address - Fax:845-358-4072
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142708207Y00000X, 207K00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00946378Medicaid
NY00946378Medicaid
NYDL024D0510Medicare ID - Type Unspecified