Healthcare Provider Details

I. General information

NPI: 1336344258
Provider Name (Legal Business Name): MATTHEW LEVINE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 NEW LOUDON RD
LATHAM NY
12110-2100
US

IV. Provider business mailing address

950 NEW LOUDON RD STE 220
LATHAM NY
12110-2100
US

V. Phone/Fax

Practice location:
  • Phone: 518-377-2448
  • Fax: 518-798-4255
Mailing address:
  • Phone: 518-377-2448
  • Fax: 518-798-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011856
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: