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General NPI Number Information
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NPI Number | 1720512049
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Entity Type | Individual
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Provider Name | JACK LEVY MD
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Gender | Male
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 12 WEST 21ST STREET 6TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10010
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Country | US
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Telephone | 212-343-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 19-07 RADBURN RD
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City | FAIR LAWN
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State | NJ
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Zip | 07410-4554
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Country | US
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Telephone | 201-370-2845
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 309233-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 25MA11062100
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 25MA11062100
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 309233-01
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 25MA11062100
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License Number State | NJ
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Taxonomy #6
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 309233-01
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License Number State | NY
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