Provider Demographics
NPI:1215903091
Name:LEVIN, HENRY STUART (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:STUART
Last Name:LEVIN
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 1:421 HUGUENOT ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-7004
Mailing Address - Country:US
Mailing Address - Phone:914-632-7882
Mailing Address - Fax:914-632-3702
Practice Address - Street 1:421 HUGUENOT ST
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-7004
Practice Address - Country:US
Practice Address - Phone:914-632-7882
Practice Address - Fax:914-632-3702
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147402207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01114929Medicaid
89D281Medicare ID - Type Unspecified
B95536Medicare UPIN