Healthcare Provider Details

I. General information

NPI: 1396745295
Provider Name (Legal Business Name): MITCHELL B LEVINE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 NORTHERN BLVD SUITE 307
GREAT NECK NY
11021
US

IV. Provider business mailing address

107 NORTHERN BLVD SUITE 307
GREAT NECK NY
11021-4309
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-3156
  • Fax: 516-482-3157
Mailing address:
  • Phone: 516-482-3156
  • Fax: 516-482-3157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberX003485
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: