Healthcare Provider Details

I. General information

NPI: 1508134743
Provider Name (Legal Business Name): DANTE MICAH LEVEN D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1789 SHEEPSHEAD BAY RD
BROOKLYN NY
11235-2792
US

IV. Provider business mailing address

315 GREENE AVENUE 4A
BROOKLYN NY
11238
US

V. Phone/Fax

Practice location:
  • Phone: 516-795-3033
  • Fax: 516-590-7684
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number280798
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number280798
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: