Healthcare Provider Details

I. General information

NPI: 1710118104
Provider Name (Legal Business Name): NATALIA LEVINSKAYA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 SUNNYSIDE BLVD STE E
PLAINVIEW NY
11803-1517
US

IV. Provider business mailing address

54 SUNNYSIDE BLVD STE E
PLAINVIEW NY
11803-1517
US

V. Phone/Fax

Practice location:
  • Phone: 516-506-7776
  • Fax: 516-719-0708
Mailing address:
  • Phone: 516-506-7776
  • Fax: 516-719-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number260076
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3554987
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: