Provider Demographics
NPI:1699715946
Name:LEVINSON, MARTIN L (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:L
Last Name:LEVINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 MANTUA PIKE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1221
Mailing Address - Country:US
Mailing Address - Phone:856-845-6000
Mailing Address - Fax:
Practice Address - Street 1:1006 MANTUA PIKE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08097-1221
Practice Address - Country:US
Practice Address - Phone:856-845-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037524E207RP1001X, 207QS1201X
NJMA03913100207RP1001X
NJ25MA03913100207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E53065Medicare UPIN
NJ173767Medicare ID - Type Unspecified