Healthcare Provider Details

I. General information

NPI: 1639267156
Provider Name (Legal Business Name): DANIEL LEVY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HIGH ST
NUTLEY NJ
07110-1132
US

IV. Provider business mailing address

777 PASSAIC AVE SUITE 360
CLIFTON NJ
07012-1804
US

V. Phone/Fax

Practice location:
  • Phone: 973-284-0020
  • Fax: 973-284-6310
Mailing address:
  • Phone: 973-284-0020
  • Fax: 973-284-6310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMA46225
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6536204
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: