Healthcare Provider Details

I. General information

NPI: 1609849546
Provider Name (Legal Business Name): LEV PUKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3049 OCEAN PKWY STE 303
BROOKLYN NY
11235-8367
US

IV. Provider business mailing address

3049 OCEAN PKWY STE 303
BROOKLYN NY
11235-8367
US

V. Phone/Fax

Practice location:
  • Phone: 718-737-7200
  • Fax: 888-960-2493
Mailing address:
  • Phone: 718-737-7200
  • Fax: 888-960-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number224460
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA07506300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number75179
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number25MA07506300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: