Healthcare Provider Details

I. General information

NPI: 1376247346
Provider Name (Legal Business Name): IVANA LEVY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E 172ND ST 3RD FL BRONX HEALTH SERVIES
BRONX NY
10460-5802
US

IV. Provider business mailing address

117 W 124TH ST FL 6
NEW YORK NY
10027-4920
US

V. Phone/Fax

Practice location:
  • Phone: 347-767-2200
  • Fax:
Mailing address:
  • Phone: 917-816-8841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number109408
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: