Healthcare Provider Details

I. General information

NPI: 1821157751
Provider Name (Legal Business Name): JENNIFER M LEVINE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E 79TH ST
NEW YORK NY
10075-1257
US

IV. Provider business mailing address

240 E 79TH ST
NEW YORK NY
10075-1257
US

V. Phone/Fax

Practice location:
  • Phone: 212-517-9400
  • Fax: 212-585-2604
Mailing address:
  • Phone: 212-517-9400
  • Fax: 212-585-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number205801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: