Healthcare Provider Details

I. General information

NPI: 1356259436
Provider Name (Legal Business Name): LIANNE LEVY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 NEW UTRECHT AVE
BROOKLYN NY
11219-1831
US

IV. Provider business mailing address

25 PARKWAY CT
BROOKLYN NY
11223-5316
US

V. Phone/Fax

Practice location:
  • Phone: 917-589-9250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: