Provider Demographics
NPI:1265523344
Name:LEVITAS, ANDREW (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LEVITAS
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 1:109 E LAUREL RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1362
Mailing Address - Country:US
Mailing Address - Phone:856-566-6034
Mailing Address - Fax:856-566-6208
Practice Address - Street 1:109 E LAUREL RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1362
Practice Address - Country:US
Practice Address - Phone:856-566-6034
Practice Address - Fax:856-566-6208
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0519012084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0729400Medicaid
NJ0729400Medicaid
NJ180614A0YMedicare PIN