Provider Demographics
NPI:1194061515
Name:LAWRENCE LEVITAN M D PLLC
Entity type:Organization
Organization Name:LAWRENCE LEVITAN M D PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-679-2223
Mailing Address - Street 1:137 E 36TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3528
Mailing Address - Country:US
Mailing Address - Phone:212-679-2223
Mailing Address - Fax:
Practice Address - Street 1:137 E 36TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3528
Practice Address - Country:US
Practice Address - Phone:212-679-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAWRENCE LEVITAN M D PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-13
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1821081787174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty