Healthcare Provider Details

I. General information

NPI: 1932532710
Provider Name (Legal Business Name): ANNIE LEVESQUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

6733 DE NORMANVILLE
MONTREAL QUEBEC
H2S 2C2
CA

V. Phone/Fax

Practice location:
  • Phone: 212-523-6874
  • Fax:
Mailing address:
  • Phone: 646-515-6368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number271669
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: