Provider Demographics
NPI:1154562361
Name:LEVINE, SEAN ETHAN (MD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:ETHAN
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1305 WALT WHITMAN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4300
Mailing Address - Country:US
Mailing Address - Phone:516-370-3796
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:777 ZECKENDORF BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2126
Practice Address - Country:US
Practice Address - Phone:516-832-8870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY255528207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01581364Medicaid