MEDICARE: JACQUELINE AVIZO LEVY M.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	235Z00000X	Speech-Language Pathologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	518303	OTHER	NY	CHICAGO INSURANCE COMPANY

General Provider Information

NPI Number	:	1699081570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE AVIZO LEVY M.S.

Provider Business Mailing Address
First Line	:	3556 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5237
Country	:	US
Telephone Number	:	917-523-3749
Fax Number	:

Provider Business Practice Location Address
First Line	:	3556 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5237
Country	:	US
Telephone Number	:	917-523-3749
Fax Number	:

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

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	08/30/2010

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Directions to “ JACQUELINE AVIZO LEVY M.S.” Practice Location

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