Healthcare Provider Details

I. General information

NPI: 1952307076
Provider Name (Legal Business Name): MICHAEL LEVGUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 EASTCHESTER RD
BRONX NY
10461-2301
US

IV. Provider business mailing address

1825 EASTCHESTER ROAD MONTEFIORE MEDICAL CENTER
BRONX NY
10461
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-2767
  • Fax: 718-904-2799
Mailing address:
  • Phone: 718-904-2767
  • Fax: 718-904-2799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number160321-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: