1174511778 NPI number — MRS. LISA SUZANNE LEWIS RPAC

Table of content: (NPI 1518550482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174511778 NPI number — MRS. LISA SUZANNE LEWIS RPAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
LISA
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAN LANDSCHOOT
Provider Other First Name:
LISA
Provider Other Middle Name:
SUZANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174511778
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 BRIARHILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-1807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-636-7909
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4949 HARLEM RD
Provider Second Line Business Practice Location Address:
UNIVERSITY ORTHOPAEDICS
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14226-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-204-3251
Provider Business Practice Location Address Fax Number:
716-891-2032
Provider Enumeration Date:
10/10/2005

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: 363AM0700X , with the licence number:  006448 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01893672 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006448 . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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