MEDICARE: DR. BRIAN MATTHEW LEVINE DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	25MD00291500	NJ

General Provider Information

NPI Number	:	1770787608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN MATTHEW LEVINE DPM

Provider Business Mailing Address
First Line	:	14 POST LN
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-4905
Country	:	US
Telephone Number	:	973-953-3275
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 SUMMIT AVE
Second Line	:	BASEMENT OFFICE
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2707
Country	:	US
Telephone Number	:	201-303-1875
Fax Number	:

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	06/17/2016

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