Provider Demographics
NPI:1255449328
Name:LAURIE J LEVINE MD PC
Entity type:Organization
Organization Name:LAURIE J LEVINE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-742-6136
Mailing Address - Street 1:200 OLD COUNTRY ROAD
Mailing Address - Street 2:STE 140
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-742-6136
Mailing Address - Fax:516-741-8130
Practice Address - Street 1:200 OLD COUNTRY ROAD
Practice Address - Street 2:STE 140
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-742-6136
Practice Address - Fax:516-741-8130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W2L381Medicare ID - Type Unspecified