Healthcare Provider Details

I. General information

NPI: 1295824290
Provider Name (Legal Business Name): DAVID BARRY LEVINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 TERRILL RD
PLAINFIELD NJ
07062-1377
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 908-941-9490
  • Fax: 908-941-9491
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08070000
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier5551315
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerCIGNA
# 2
Identifier2765828000
Identifier TypeOTHER
Identifier State
Identifier IssuerAMERIHEALTH
# 3
Identifier3K5368
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerHEALTH NET

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: