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General NPI Number Information
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NPI Number | 1306936059
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Entity Type | Organization
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Legal Business Name | MARK M LEVINE DPM PC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 67-09 75 STREET
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379
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Country | US
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Telephone | 718-894-9291
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Fax | 718-894-9745
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Provider Business Mailing Address
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Address Line | 67-09 75 STREET
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379
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Country | US
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Telephone | 718-894-9291
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Fax | 718-894-9745
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. MARK LEVINE
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Credential | DPM
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Telephone | 718-894-9291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N003194
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License Number State | NY
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