Provider Demographics
NPI:1619777141
Name:LEVENSON, JESSE SEAN (DPT)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:SEAN
Last Name:LEVENSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:JESSE
Other - Middle Name:SEAN
Other - Last Name:LEVENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:571 ALBERT ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4947
Mailing Address - Country:US
Mailing Address - Phone:516-592-0048
Mailing Address - Fax:
Practice Address - Street 1:475 NORTHERN BLVD STE 11
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4802
Practice Address - Country:US
Practice Address - Phone:516-829-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist