1164595054 NPI number — MS. DAWN E LEWIS

Table of content: MS. DAWN E LEWIS (NPI 1164595054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164595054 NPI number — MS. DAWN E LEWIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
DAWN
Provider Middle Name:
E
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARTH
Provider Other First Name:
DAWN
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164595054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3500 SUNRISE HWY
Provider Second Line Business Mailing Address:
BUILDING 300, SUITE 403
Provider Business Mailing Address City Name:
GREAT RIVER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11739-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-854-0164
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 SUNRISE HWY
Provider Second Line Business Practice Location Address:
BUILDING 300, SUITE 403
Provider Business Practice Location Address City Name:
GREAT RIVER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11739-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-854-0164
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2006

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 116000464 . This is a "TAX ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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