Basic Information
| Provider Information | |||||||||
| NPI: | 1053619205 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEV | ||||||||
| FirstName: | MARINA | ||||||||
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| OtherLastName: | LEV | ||||||||
| OtherFirstName: | MARINA | ||||||||
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| OtherCredential: | RPA-C | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9269 SHORE RD APT F3 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112096608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176130856 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2601 OCEAN PKWY | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112357745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186163440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2011 | ||||||||
| LastUpdateDate: | 09/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 009716-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.