Provider Demographics
NPI:1063788115
Name:DAVID ANDRE' LEVI, M.D. PEDIATRICS, PLLC
Entity type:Organization
Organization Name:DAVID ANDRE' LEVI, M.D. PEDIATRICS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANDRE'
Authorized Official - Last Name:LEVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-965-3670
Mailing Address - Street 1:984 NORTH BROADWAY SUITE 315
Mailing Address - Street 2:HUDSON RIVER PEDIATRICS
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701
Mailing Address - Country:US
Mailing Address - Phone:914-965-3670
Mailing Address - Fax:914-965-7857
Practice Address - Street 1:984 NORTH BROADWAY
Practice Address - Street 2:SUITE315
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:914-965-3670
Practice Address - Fax:914-965-7857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210287208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02580707Medicaid