Healthcare Provider Details

I. General information

NPI: 1083724884
Provider Name (Legal Business Name): LEVY PSYCHIATRIC ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 ROOSEVELT BLVD SUITE 100
PHILADELPHIA PA
19152
US

IV. Provider business mailing address

8001 ROOSEVELT BLVD SUITE 100
PHILADELPHIA PA
19152
US

V. Phone/Fax

Practice location:
  • Phone: 215-333-7560
  • Fax: 215-333-7563
Mailing address:
  • Phone: 215-333-7560
  • Fax: 215-333-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH M LEVY
Title or Position: PSYCHIATRIST
Credential: DO
Phone: 215-333-7560