Healthcare Provider Details

I. General information

NPI: 1417179656
Provider Name (Legal Business Name): SANDRA LUCINDA LEVINE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

METROPOLITAN HOSPITAL CENTER 1901 FIRST AVENUE 12 FLR
NEW YORK NY
10029
US

IV. Provider business mailing address

3349 BAYCHESTER AVE PH
BRONX NY
10469-2621
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011738
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: