1730121799 NPI number — DR. MICHAEL P LEWKO MD

Table of content: DR. MICHAEL P LEWKO MD (NPI 1730121799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730121799 NPI number — DR. MICHAEL P LEWKO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWKO
Provider First Name:
MICHAEL
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730121799
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
871 ALLWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIFTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-495-5163
Provider Business Mailing Address Fax Number:
973-365-8004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
871 ALLWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIFTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-405-5163
Provider Business Practice Location Address Fax Number:
973-365-8004
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  25MA05034900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10782 . This is a "AMERICAID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1799910 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1223801 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5272003 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2K1273 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 91G241 . This is a "WELLCHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 930118775 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7127953004 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1150924 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 37H702 . This is a "EMPIRE HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2540466 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: PS000015406 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0438532000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".




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