Individual
DR. JACK M. LEVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6940 MAIN ST, KEW GARDENS HILLS, NY 11367-1723
(718) 268-5282
Mailing address
5 ASPEN PL, GREAT NECK, NY 11021-2810
(516) 466-5255
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
145681
NY
2080P0006X
Developmental - Behavioral Pediatrics Physician
145681
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00801390
—
NY
Enumeration date
10/27/2006
Last updated
12/28/2020
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