=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154481042
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT D. LEVY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 08/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4423 ROUTE 130 S
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08016-2385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-386-0202
-----------------------------------------------------
Fax | 609-386-5927
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4423 ROUTE 130 S
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08016-2385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-386-0202
-----------------------------------------------------
Fax | 609-386-5927
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT DEAN LEVY
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 609-386-0202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 27OA00526400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------