MEDICARE: SARATOGA EAR & SINUS SURGERY, 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	207Y00000X	Otolaryngology Physician	1172401	NY

General Provider Information

NPI Number	:	1730134503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARATOGA EAR & SINUS SURGERY, PC

Provider Business Mailing Address
First Line	:	54 SEWARD ST
Second Line	:
City	:	SARATOGA SPGS
State	:	NY
Zip	:	12866-1143
Country	:	US
Telephone Number	:	518-587-2300
Fax Number	:	518-587-2656

Provider Business Practice Location Address
First Line	:	54 SEWARD ST
Second Line	:
City	:	SARATOGA SPGS
State	:	NY
Zip	:	12866-1143
Country	:	US
Telephone Number	:	518-587-2300
Fax Number	:	518-587-2656

Authorized Official
Title or Position	:	MD/OWNER
Name	:	DR. MARK LEVENSON
Credential	:	MD
Telephone Number	:	518-587-2300

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	11/04/2014

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