Individual
JACQUELINE LEVITT
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
462 GRIDER ST, BUFFALO, NY 14215-3021
(716) 898-3000
Mailing address
2875 UNION RD, SUITE 8, CHEEKTOWAGA, NY 14227-1465
(716) 651-0911
(716) 651-9855
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
110915
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010103504
UNIVERA
NY
01
—
000508352005
BC/BS
NY
05
—
00697778
—
NY
01
—
0409734
IHA
NY
01
—
10177540
FIDELIS
NY
01
—
151125BJ
PREFERRED CARE
NY
Enumeration date
10/24/2005
Last updated
07/08/2007
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