Provider Demographics
NPI:1386614204
Name:LEVAT, GARY S (DPM)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:LEVAT
Suffix:
Gender:M
Credentials:DPM
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Other - First Name:
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Mailing Address - Street 1:125 NEWTON SPARTA RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2812
Mailing Address - Country:US
Mailing Address - Phone:973-300-2450
Mailing Address - Fax:973-300-2455
Practice Address - Street 1:125 NEWTON SPARTA RD STE 2
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860
Practice Address - Country:US
Practice Address - Phone:973-300-2450
Practice Address - Fax:973-300-2455
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MD00148400213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1561405Medicaid
NJT44907Medicare UPIN
NJ418637Medicare PIN