Provider Demographics
NPI:1124175419
Name:LEVANDOWSKI, RICHARD (MD,)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:LEVANDOWSKI
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 PRINCETON PIKE
Mailing Address - Street 2:BLDG. 4, SUITE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2201
Mailing Address - Country:US
Mailing Address - Phone:609-896-9190
Mailing Address - Fax:609-896-3555
Practice Address - Street 1:3131 PRINCETON PIKE
Practice Address - Street 2:BLDG. 4, SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2201
Practice Address - Country:US
Practice Address - Phone:609-896-9190
Practice Address - Fax:609-896-3555
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA33347207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ435436Medicare PIN
NJC54336Medicare UPIN
NJ435436Medicare ID - Type Unspecified