MEDICARE: DR. HERBERT MARK LEVITT D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	028102	NY

General Provider Information

NPI Number	:	1255633962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HERBERT MARK LEVITT D.D.S.

Provider Business Mailing Address
First Line	:	2498 AMSTERDAM AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-3327
Country	:	US
Telephone Number	:	212-927-4275
Fax Number	:

Provider Business Practice Location Address
First Line	:	2498 AMSTERDAM AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-3327
Country	:	US
Telephone Number	:	212-927-4275
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	12/01/2010

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