Healthcare Provider Details

I. General information

NPI: 1104157791
Provider Name (Legal Business Name): DANIEL L. LEVIN, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 06/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SCHOOL ST
GLEN COVE NY
11542-2590
US

IV. Provider business mailing address

3 SCHOOL ST
GLEN COVE NY
11542-2590
US

V. Phone/Fax

Practice location:
  • Phone: 516-676-1222
  • Fax: 516-676-1933
Mailing address:
  • Phone: 516-676-1222
  • Fax: 516-676-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number108785
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number108785
License Number StateNY

VIII. Authorized Official

Name: DANIEL L LEVIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-676-1222