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Individual

DR. JACK LEVY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
12 WEST 21ST STREET, 6TH FLOOR, NEW YORK, NY 10010
(212) 343-2222
Mailing address
19-07 RADBURN RD, FAIR LAWN, NJ 07410-4554
(201) 370-2845

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
25MA11062100
NJ
207N00000X
Dermatology Physician
309233-01
NY
207ND0101X
MOHS-Micrographic Surgery Physician
25MA11062100
NJ
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
309233-01
NY
207NS0135X
Procedural Dermatology Physician
25MA11062100
NJ
207NS0135X
Procedural Dermatology Physician
309233-01
NY
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
04/13/2017
Last updated
10/27/2022
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