Healthcare Provider Details

I. General information

NPI: 1750478251
Provider Name (Legal Business Name): HOWARD J LEVINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 EAST 83 STREET
BROOKLYN NY
11236-3813
US

IV. Provider business mailing address

1023 HAZEL PLACE
WOODMERE NY
11598-1109
US

V. Phone/Fax

Practice location:
  • Phone: 718-444-6500
  • Fax: 718-444-3728
Mailing address:
  • Phone: 516-295-2128
  • Fax: 718-444-3728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number140622
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00629263
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: