Provider Demographics
NPI:1174742704
Name:TEPPER-LEVINE, SHAWN (DO)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:TEPPER-LEVINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08528-0142
Mailing Address - Country:US
Mailing Address - Phone:609-924-0496
Mailing Address - Fax:609-945-2535
Practice Address - Street 1:20 HEATHCOTE ROAD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:08528-0142
Practice Address - Country:US
Practice Address - Phone:609-924-0496
Practice Address - Fax:609-945-2535
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07928000204D00000X
NY225372204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH76707Medicare UPIN
NJ094270Medicare ID - Type Unspecified