Provider Demographics
NPI:1982608485
Name:LEVINE, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:LEVINE
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 1:581 N FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1139
Mailing Address - Country:US
Mailing Address - Phone:201-236-2100
Mailing Address - Fax:201-236-5269
Practice Address - Street 1:581 N FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1139
Practice Address - Country:US
Practice Address - Phone:201-236-2100
Practice Address - Fax:201-236-5269
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03774100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ09D801OtherEMPIRE BC/BS (MIDLAND PK)
NJ4243562OtherAETNA PPO ID #
NJ38018OtherAETNA HMO ID #
NJ0K5796OtherHEALTHNET ID #
NJ160054353OtherRAILROAD MDCR #
NJ09D803OtherEMPIRE BC/BS (RAMSEY)
NJBP185OtherOXFORD ID #
NJD18993Medicare UPIN
NJ452665C7CMedicare PIN