Provider Demographics
NPI:1053619205
Name:LEV, MARINA
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:LEV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:LEV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPA-C
Mailing Address - Street 1:9269 SHORE RD APT F3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6608
Mailing Address - Country:US
Mailing Address - Phone:917-613-0856
Mailing Address - Fax:
Practice Address - Street 1:2601 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7745
Practice Address - Country:US
Practice Address - Phone:718-616-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009716-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical