Provider Demographics
NPI:1730564832
Name:MARK J. LEVITAN, D.C., P.C.
Entity type:Organization
Organization Name:MARK J. LEVITAN, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEVITAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-359-8746
Mailing Address - Street 1:105 MAXESS RD
Mailing Address - Street 2:SUITE S131
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3851
Mailing Address - Country:US
Mailing Address - Phone:516-359-8746
Mailing Address - Fax:631-393-6837
Practice Address - Street 1:105 MAXESS RD
Practice Address - Street 2:SUITE S131
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3851
Practice Address - Country:US
Practice Address - Phone:516-359-8746
Practice Address - Fax:631-393-6837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004472-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty