Provider Demographics
NPI:1275519282
Name:LEVY, ERNEST R (MD)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:R
Last Name:LEVY
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 1:1 FOX CARE DR
Mailing Address - Street 2:STE 104 FOX CARE CENTER
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820
Mailing Address - Country:US
Mailing Address - Phone:607-432-7178
Mailing Address - Fax:607-432-8274
Practice Address - Street 1:1 FOX CARE DR
Practice Address - Street 2:STE 104 FOX CARE CENTER
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820
Practice Address - Country:US
Practice Address - Phone:607-432-7178
Practice Address - Fax:607-432-8274
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY193010207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
148112OtherMVP
10032577OtherCDPHP
NYP747658OtherOXFORD
NY0068645OtherGHI
NY990005900OtherRR MEDICARE
NY56808BMedicare ID - Type Unspecified