Healthcare Provider Details

I. General information

NPI: 1528639424
Provider Name (Legal Business Name): WILLIAM GARY LEVERTON II NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEROES WAY
RIVERHEAD NY
11901-2058
US

IV. Provider business mailing address

105 PAM CT
BOHEMIA NY
11716-3813
US

V. Phone/Fax

Practice location:
  • Phone: 631-548-6467
  • Fax:
Mailing address:
  • Phone: 631-805-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number432095
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number703112
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: