Individual provider Active NPI

Mark J Levitan, D.C.

  • Chiropractor
  • Commack, NY
National Provider Identifier
1063809143
Registry record updated Feb 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
X004472-1 Issued in NY
Practice address
36 Madder Lake Cir
Commack, NY 11725-2340
Phone
(516) 359-8746
Fax
(631) 352-2527
NPI assigned
Apr 16, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 8, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X X004472-1 NY Primary

Addresses

Primary practice location

36 Madder Lake Cir
Commack, NY 11725-2340

Mailing address

36 Madder Lake Cir
Commack, NY 11725-2340
Phone (516) 359-8746

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190313000864 NY Practitioner - Chiropractic 6002156965 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
X004472-1NYMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Mark J. Levitan, D.C., P.C. Chiropractor CurrentSince Mar 18, 2019 Accepting new patients

Locations

150 Veterans Memorial Hwy
Unit 6
Commack, NY 11725

406 Larkfield Rd
East Northport, NY 11731
Phone (631) 722-1722

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549584000000",
    "number": "1063809143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 MADDER LAKE CIR",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252340",
            "telephone_number": "516-359-8746",
            "fax_number": "631-352-2527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 MADDER LAKE CIR",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252340",
            "telephone_number": "516-359-8746",
            "fax_number": "631-352-2527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEVITAN",
        "first_name": "MARK",
        "middle_name": "J",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-16",
        "last_updated": "2019-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X004472-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Commack, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.