Healthcare Provider Details

I. General information

NPI: 1912900416
Provider Name (Legal Business Name): JONATHAN A LEVISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 BROAD ST
CLIFTON NJ
07013-4236
US

IV. Provider business mailing address

433 CENTRAL AVE
WESTFIELD NJ
07090-2520
US

V. Phone/Fax

Practice location:
  • Phone: 973-759-9000
  • Fax: 973-751-3730
Mailing address:
  • Phone: 973-759-9000
  • Fax: 973-759-2487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MAO6867000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA06867000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: