Healthcare Provider Details

I. General information

NPI: 1144394214
Provider Name (Legal Business Name): KEITH S LEVENTHAL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2374 JERUSALEM AVE
NORTH BELLMORE NY
11710-1825
US

IV. Provider business mailing address

2374 JERUSALEM AVE
N BELLMORE NY
11710-1825
US

V. Phone/Fax

Practice location:
  • Phone: 516-409-8311
  • Fax: 516-409-8313
Mailing address:
  • Phone: 516-409-8311
  • Fax: 516-409-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number208565
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: