Provider Demographics
NPI:1033215934
Name:LEWIS, JANET LISA (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LISA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 KIMBALL AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527
Mailing Address - Country:US
Mailing Address - Phone:315-536-6050
Mailing Address - Fax:315-536-6050
Practice Address - Street 1:108 KIMBALL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527
Practice Address - Country:US
Practice Address - Phone:315-536-6050
Practice Address - Fax:315-536-6050
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1993132084P0800X
TN236612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3513OtherEXCELLUS
NY01592754Medicaid
NY3513OtherEXCELLUS
D1763HMedicare UPIN