Provider Demographics
NPI:1386712032
Name:LEVY, ANDREW S (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 MILLBURN AVENUE
Mailing Address - Street 2:SUITE 204A
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041
Mailing Address - Country:US
Mailing Address - Phone:908-598-9199
Mailing Address - Fax:973-762-4518
Practice Address - Street 1:90 MILLBURN AVENUE
Practice Address - Street 2:SUITE 204A
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041
Practice Address - Country:US
Practice Address - Phone:908-598-9199
Practice Address - Fax:973-762-4518
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA062614207XX0005X
NJMA06261400207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLE785659Medicare ID - Type Unspecified
G09941Medicare UPIN