Healthcare Provider Details

I. General information

NPI: 1972259158
Provider Name (Legal Business Name): KATHY LEVITSKIY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 CLINTON STREET EXT
MC GRAW NY
13101-9443
US

IV. Provider business mailing address

3640 CLINTON STREET EXT
MC GRAW NY
13101-9443
US

V. Phone/Fax

Practice location:
  • Phone: 315-849-6421
  • Fax:
Mailing address:
  • Phone: 315-849-6421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA067795
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: