Basic Information
| Provider Information | |||||||||
| NPI: | 1437286648 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEVITZ | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 285 COUNTY ROUTE 47, PO BOX 471 | ||||||||
| Address2: | SARANAC LAKE HEALTH CENTER | ||||||||
| City: | SARANAC LAKE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129835403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188972850 | ||||||||
| FaxNumber: | 5188972605 | ||||||||
| Practice Location | |||||||||
| Address1: | 285 COUNTY ROUTE 47 | ||||||||
| Address2: | SARANAC LAKE HEALTH CENTER | ||||||||
| City: | SARANAC LAKE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129835403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188972850 | ||||||||
| FaxNumber: | 5188972605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 01/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | F330536-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | ML0145323 | 01 | NY | DEA | OTHER |