Provider Demographics
NPI:1114070398
Name:LEWANDOWSKI, KENNETH (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:LEWANDOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 NEWMAN SPRINGS ROAD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738
Mailing Address - Country:US
Mailing Address - Phone:732-677-9937
Mailing Address - Fax:732-842-4536
Practice Address - Street 1:521 NEWMAN SPRINGS ROAD
Practice Address - Street 2:SUITE 21
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738
Practice Address - Country:US
Practice Address - Phone:732-677-9937
Practice Address - Fax:732-842-4536
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB57910207R00000X
NJ25MB05791000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ203629YETNOtherPTAN
NJF24139Medicare UPIN