MEDICARE: EDWARD J LEVINE MD

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	261QP2300X	Primary Care Clinic/Center	152068	NY
2	207R00000X	Internal Medicine Physician	152068	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689761926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD J LEVINE MD

Provider Business Mailing Address
First Line	:	1491 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2311
Country	:	US
Telephone Number	:	718-273-6999
Fax Number	:	718-273-4394

Provider Business Practice Location Address
First Line	:	1491 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2311
Country	:	US
Telephone Number	:	718-273-6999
Fax Number	:	718-273-4394

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	03/15/2018

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