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General NPI Number Information
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NPI Number | 1205017183
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL MEDICAL
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 500 SEAVIEW AVE SUITE 200A
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City | STATEN ISLAND
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State | NY
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Zip | 10305-3403
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Country | US
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Telephone | 718-351-8100
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Fax | 718-351-4560
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Provider Business Mailing Address
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Address Line | 500 SEAVIEW AVE SUITE 200A
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City | STATEN ISLAND
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State | NY
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Zip | 10305-3403
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Country | US
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Telephone | 718-351-8100
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Fax | 718-351-4560
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL T. LEVY
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Credential | M.D.
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Telephone | 718-351-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744R1102X
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Taxonomy Name | Research Study Specialist
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License Number | 1068051
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License Number State | NY
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