Provider Demographics
NPI:1699081570
Name:AVIZO LEVY, JACQUELINE (MS)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:AVIZO LEVY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:AZIZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3556 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5237
Mailing Address - Country:US
Mailing Address - Phone:917-523-3749
Mailing Address - Fax:
Practice Address - Street 1:3556 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5237
Practice Address - Country:US
Practice Address - Phone:917-523-3749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY518303OtherCHICAGO INSURANCE COMPANY