=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144705468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE GUSTAVE L LEVY PLACE INDEPENDENT PRACTICE ASSOCIATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2018
-----------------------------------------------------
Last Update Date | 10/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 GUSTAVE L LEVY PL
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10029-6504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-635-0305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 49 MUSIC SQ W
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37203-3213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-635-0305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | AARON STEIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-635-0305
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------