MEDICARE: MARTIN RYAN LEVY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		NY

General Provider Information

NPI Number	:	1457011462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN RYAN LEVY

Provider Business Mailing Address
First Line	:	1 WINSTON CT
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-5301
Country	:	US
Telephone Number	:	813-767-7511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 WINSTON CT
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-5301
Country	:	US
Telephone Number	:	813-767-7511
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2021
Last Update Date	:	12/19/2021

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Directions to “ MARTIN RYAN LEVY ” Practice Location

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