=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366473845
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAY GARY LEVINE DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 04/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 OLD NYACK TURNPIKE SUITE 407
-----------------------------------------------------
City | NANUET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10954-2452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-623-5933
-----------------------------------------------------
Fax | 845-623-4261
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 OLD NYACK TURNPIKE SUITE 407
-----------------------------------------------------
City | NANUET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10954-2452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-623-5933
-----------------------------------------------------
Fax | 845-623-4261
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | N0041131
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | N0041131
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | MD001821
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------