1174511778 NPI number — MRS. LISA SUZANNE LEWIS RPAC

Table of content: MRS. LISA SUZANNE LEWIS RPAC (NPI 1174511778)

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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