Healthcare Provider Details

I. General information

NPI: 1356429518
Provider Name (Legal Business Name): PAUL A LEVY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHAM 3415 BAINBRIDGE AVENUE
BRONX NY
10467
US

IV. Provider business mailing address

3415 BAINBRIDGE AVE PEDIATRIC GENETICS
BRONX NY
10467-2403
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2323
  • Fax: 718-920-6506
Mailing address:
  • Phone: 718-741-2323
  • Fax: 718-920-6506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number178748
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number178748
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License Number178748
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: