Healthcare Provider Details

I. General information

NPI: 1720354327
Provider Name (Legal Business Name): REBECCA LEVY MBCHB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-2403
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 675
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6440
  • Fax:
Mailing address:
  • Phone: 585-275-1554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number308151
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number308151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: