Healthcare Provider Details

I. General information

NPI: 1750552048
Provider Name (Legal Business Name): RICHARD LEVINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MADISON AVE SUITE B
MOUNT HOLLY NJ
08060-2055
US

IV. Provider business mailing address

120 MADISON AVE SUITE B
MOUNT HOLLY NJ
08060-2055
US

V. Phone/Fax

Practice location:
  • Phone: 609-261-6701
  • Fax: 609-261-9362
Mailing address:
  • Phone: 609-261-6701
  • Fax: 609-261-9362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number25MA03356800
License Number StateNJ

VIII. Authorized Official

Name: DR. RICHARD TEDDY LEVINE
Title or Position: PARTNER
Credential: MD
Phone: 609-261-4925