Provider Demographics
NPI:1003707159
Name:LEVINE, JAY
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:LEVINE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W 64TH ST APT 40J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7141
Mailing Address - Country:US
Mailing Address - Phone:917-374-0840
Mailing Address - Fax:
Practice Address - Street 1:CHATEAU DRUG AND HOMECARE
Practice Address - Street 2:181 AMSTERDAM AVE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-877-6390
Practice Address - Fax:212-877-6706
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist