Basic Information
| Provider Information | |||||||||
| NPI: | 1467669143 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVINE | ||||||||
| FirstName: | JEFFREY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 AVE DE LA CONSTITUCION | ||||||||
| Address2: | APTO 1002 COND MILENNIUM | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009012312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162982558 | ||||||||
| FaxNumber: | 7879778010 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 AVE DE LA CONSTITUCION | ||||||||
| Address2: | APTO 1002 COND MILENNIUM | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009012312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162982558 | ||||||||
| FaxNumber: | 7879778010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 15777 | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.