MEDICARE: HERB LEVITT DDS PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1255633962	OTHER	NY	INDIVIDUAL NPI NUMBER

General Provider Information

NPI Number	:	1407294358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERB LEVITT DDS PC

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	:	212-927-4278

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	:	212-927-4278

Authorized Official
Title or Position	:	OWNER
Name	:	HERBERT M LEVITT
Credential	:	D.D.S.
Telephone Number	:	212-927-4275

Provider Enumeration Date	:	06/12/2013
Last Update Date	:	06/12/2013

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