MEDICARE: MS. ELLEN LEVINE M.A.

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	235500000X	Speech/Language/Hearing Specialist/Technologist	345967031	NY

General Provider Information

NPI Number	:	1942506662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN LEVINE M.A.

Provider Business Mailing Address
First Line	:	2714 BAINBRIDGE AVE APT 1E
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-4041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2714 BAINBRIDGE AVE APT 1E
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-4041
Country	:	US
Telephone Number	:	718-364-5792
Fax Number	:

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

Provider Enumeration Date	:	01/27/2011
Last Update Date	:	01/27/2011

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