Provider Demographics
NPI:1699951210
Name:LEVIN, MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LEVIN
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 1:623 RIVER RD
Mailing Address - Street 2:SUITE 2R
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3200
Mailing Address - Country:US
Mailing Address - Phone:732-977-8486
Mailing Address - Fax:714-443-0202
Practice Address - Street 1:623 RIVER RD
Practice Address - Street 2:SUITE 2R
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704-3200
Practice Address - Country:US
Practice Address - Phone:732-977-8486
Practice Address - Fax:714-443-0202
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2346232084P0800X
CAA1127722084P0804X
NJ25MA099334002084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry