Provider Demographics
NPI:1386797868
Name:LAVINE, SEAN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:DAVID
Last Name:LAVINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:710 W 168TH ST
Mailing Address - Street 2:NI-424
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3726
Mailing Address - Country:US
Mailing Address - Phone:212-305-0135
Mailing Address - Fax:212-305-3629
Practice Address - Street 1:710 W 168TH ST
Practice Address - Street 2:NI-424
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3726
Practice Address - Country:US
Practice Address - Phone:212-305-0135
Practice Address - Fax:212-305-3629
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2022-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2235852085R0204X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02255365Medicaid
NY694921Medicare ID - Type Unspecified
NY02255365Medicaid