1063612877 NPI number — LEWIN FURNITURE-FUNERAL HOME INC

Table of content: VEENA KAWATRA GUPTA M.D. (NPI 1790713899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063612877 NPI number — LEWIN FURNITURE-FUNERAL HOME INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEWIN FURNITURE-FUNERAL HOME INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1063612877
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 WOLF RIVER DR
Provider Second Line Business Mailing Address:
PO BOX 393
Provider Business Mailing Address City Name:
FREMONT
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54940-9052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-446-2288
Provider Business Mailing Address Fax Number:
920-446-2448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 WOLF RIVER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54940-9052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-446-2288
Provider Business Practice Location Address Fax Number:
920-446-2448
Provider Enumeration Date:
07/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIN
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
920-446-2288

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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