Healthcare Provider Details

I. General information

NPI: 1710274022
Provider Name (Legal Business Name): JASON P LEVY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1773 KUSER RD
HAMILTON NJ
08690-3703
US

IV. Provider business mailing address

1773 KUSER RD
HAMILTON NJ
08690-3703
US

V. Phone/Fax

Practice location:
  • Phone: 609-585-4433
  • Fax: 609-585-8288
Mailing address:
  • Phone: 609-585-4433
  • Fax: 609-585-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00321300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006565
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: