Provider Demographics
NPI:1992805436
Name:RANDY L. LEVINE, M.D., P.C.
Entity type:Organization
Organization Name:RANDY L. LEVINE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-717-1020
Mailing Address - Street 1:920 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0208
Mailing Address - Country:US
Mailing Address - Phone:212-717-1020
Mailing Address - Fax:212-717-0972
Practice Address - Street 1:920 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0208
Practice Address - Country:US
Practice Address - Phone:212-717-1020
Practice Address - Fax:212-717-0972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-24
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145824207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS701OtherOXFORD
NY4295094OtherAETNA PPO
NY3230316OtherAETNA HMO
NY2Z136OtherBLUE CROSS/BLUE SHIELD
NY3230316OtherAETNA HMO
NY2Z136OtherBLUE CROSS/BLUE SHIELD