=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528201217
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA LYNN LEVY DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2009
-----------------------------------------------------
Last Update Date | 01/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37 NORTH AVE SUITE 103
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06851-3827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-817-2534
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 74 PENNSYLVANIA AVE
-----------------------------------------------------
City | TUCKAHOE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10707-2725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-841-7780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 010473
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 054639
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------