Healthcare Provider Details

I. General information

NPI: 1306765854
Provider Name (Legal Business Name): JACOB LEVIN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2058 JEROME AVE UNIT 3
BRONX NY
10453-1817
US

IV. Provider business mailing address

600 COLUMBUS AVE APT 11R
NEW YORK NY
10024-1439
US

V. Phone/Fax

Practice location:
  • Phone: 914-844-5828
  • Fax:
Mailing address:
  • Phone: 914-844-5828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP137208
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: