Healthcare Provider Details

I. General information

NPI: 1760456016
Provider Name (Legal Business Name): BARRY E. LEVANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 KIEL AVE
KINNELON NJ
07405-2565
US

IV. Provider business mailing address

15 KIEL AVE
KINNELON NJ
07405-2565
US

V. Phone/Fax

Practice location:
  • Phone: 973-838-4098
  • Fax: 973-838-7628
Mailing address:
  • Phone: 973-838-4098
  • Fax: 973-838-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33660
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: