Provider Demographics
NPI:1053787382
Name:LEVY, DAVID EDWARD (RN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:LEVY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6909 172ND ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3319
Mailing Address - Country:US
Mailing Address - Phone:347-256-5044
Mailing Address - Fax:
Practice Address - Street 1:6909 172ND ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3319
Practice Address - Country:US
Practice Address - Phone:347-256-5044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15829100163W00000X
NY534177163WA2000X, 163WC0200X, 163WH0200X, 163WH0500X, 163WH1000X, 163WP0000X, 163WS0200X
FLRN 9382362163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY70691OtherIPRO PRI & H/C-PRI ASSESSOR CERTIFICATION-APPROVED BY NY STATE DEPT OF HEALTH