Provider Demographics
NPI:1528639424
Name:LEVERTON, WILLIAM GARY II (NP)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GARY
Last Name:LEVERTON
Suffix:II
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PAM CT
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-3813
Mailing Address - Country:US
Mailing Address - Phone:631-805-1740
Mailing Address - Fax:
Practice Address - Street 1:HSC T12 ROOM 080 NY SPINE AND BRAIN SURGERY
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-1116
Practice Address - Fax:631-444-1535
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY703112163WE0003X
NY432095363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergency