1295755171 NPI number — SUSAN E. LEWIN DPM

Table of content: CHRISTOPHER W JACKSON ATC, CEAS (NPI 1942441126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295755171 NPI number — SUSAN E. LEWIN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIN
Provider First Name:
SUSAN
Provider Middle Name:
E.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

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:
1295755171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
913 N CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODMERE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11598-1629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-930-7479
Provider Business Mailing Address Fax Number:
516-569-3294

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2146 BEVERLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11226-5406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-210-3296
Provider Business Practice Location Address Fax Number:
877-868-8633
Provider Enumeration Date:
07/20/2006

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: 213E00000X , with the licence number:  N005630 , 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: 02519726 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02205127 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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