Provider Demographics
NPI:1386622579
Name:LEVINE, STUART R (DO)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:R
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N VILLAGE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1078
Mailing Address - Country:US
Mailing Address - Phone:516-763-1717
Mailing Address - Fax:516-678-4996
Practice Address - Street 1:2000 N VILLAGE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1078
Practice Address - Country:US
Practice Address - Phone:516-763-1717
Practice Address - Fax:516-678-4996
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197033207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400036697Medicare PIN
405602Medicare PIN