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Individual

MR. JACK EDWARD LEVINE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
6 NANCY LANE, CHAPPAQUA, NY 10514-2111
(914) 238-6247
(914) 238-1737
Mailing address
6 NANCY LANE, CHAPPAQUA, NY 10514-2111
(914) 238-6247
(914) 238-1737

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
106392
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00644720
NY
Enumeration date
06/25/2009
Last updated
06/25/2009
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