Provider Demographics
NPI:1548273030
Name:LEVINE, ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COMMONS DR
Mailing Address - Street 2:TEN BROECK COMMONS
Mailing Address - City:LAKE KATRINE
Mailing Address - State:NY
Mailing Address - Zip Code:12449-5149
Mailing Address - Country:US
Mailing Address - Phone:845-336-6666
Mailing Address - Fax:845-336-4014
Practice Address - Street 1:1 COMMONS DR
Practice Address - Street 2:TEN BROECK COMMONS
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5149
Practice Address - Country:US
Practice Address - Phone:845-336-6666
Practice Address - Fax:845-336-4014
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195514208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01582425Medicaid
NYGO8496Medicare UPIN
NY01582425Medicaid
NY44J16Medicare ID - Type Unspecified