MEDICARE: ELIZABETH LEVY

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	363AS0400X	Surgical Physician Assistant	020787-1	NY
2	363AS0400X	Surgical Physician Assistant	PA60838	CA
3	363AS0400X	Surgical Physician Assistant	PA9110072	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	020787-1	OTHER	NY	PHYSICIAN ASSISTANT LICENSE
2	PA60838	OTHER	CA	PHYSICIAN ASSISTANT
3	PA9110072	OTHER	FL	PHYSICIAN ASSISTANT LICENSE

General Provider Information

NPI Number	:	1689111684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH LEVY

Provider Business Mailing Address
First Line	:	14000 MARQUESAS WAY APT 1213
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-7521
Country	:	US
Telephone Number	:	845-598-2481
Fax Number	:

Provider Business Practice Location Address
First Line	:	14000 MARQUESAS WAY APT 1213
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-7521
Country	:	US
Telephone Number	:	845-598-2481
Fax Number	:

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

Provider Enumeration Date	:	01/27/2017
Last Update Date	:	05/04/2026

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Directions to “ ELIZABETH LEVY ” Practice Location

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