Healthcare Provider Details

I. General information

NPI: 1255821047
Provider Name (Legal Business Name): LEVI DANIEL DYGERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 FRONT ST STE 400
EAST MEADOW NY
11554-2265
US

IV. Provider business mailing address

14 WALL ST FL 9
NEW YORK NY
10005-2178
US

V. Phone/Fax

Practice location:
  • Phone: 516-324-7500
  • Fax: 929-455-9653
Mailing address:
  • Phone: 646-501-3224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number316928
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: