Healthcare Provider Details

I. General information

NPI: 1023017316
Provider Name (Legal Business Name): MALCOLM E LEVINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NORTHERN BLVD
MANHASSET NY
11030-3001
US

IV. Provider business mailing address

1201 NORTHERN BLVD
MANHASSET NY
11030-3001
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-1221
  • Fax: 516-627-6857
Mailing address:
  • Phone: 516-627-1221
  • Fax: 516-627-6857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number093658
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: