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General NPI Number Information
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NPI Number | 1336377654
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Entity Type | Individual
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Provider Name | JACK EDWARD LEVINE MD
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Gender | Male
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 06/25/2009
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Provider Practice Location Address
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Address Line | 6 NANCY LANE
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City | CHAPPAQUA
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State | NY
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Zip | 10514-2111
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Country | US
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Telephone | 914-238-6247
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Fax | 914-238-1737
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Provider Business Mailing Address
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Address Line | 6 NANCY LANE
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City | CHAPPAQUA
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State | NY
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Zip | 10514-2111
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Country | US
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Telephone | 914-238-6247
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Fax | 914-238-1737
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 106392
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License Number State | NY
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