Provider Demographics
NPI:1548348931
Name:LEVITT, MIRIAM (MD)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:LEVITT
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 1:10 LOCKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5302
Mailing Address - Country:US
Mailing Address - Phone:914-723-4236
Mailing Address - Fax:
Practice Address - Street 1:1 PONDFIELD RD
Practice Address - Street 2:SUITE 303
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3706
Practice Address - Country:US
Practice Address - Phone:914-961-3604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113936208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00208306Medicaid
NY00208306Medicaid