Provider Demographics
NPI:1134128960
Name:SIMS, LEWIS J (DPM)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:J
Last Name:SIMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19 BAKER AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1375
Mailing Address - Country:US
Mailing Address - Phone:845-471-2243
Mailing Address - Fax:845-471-2883
Practice Address - Street 1:19 BAKER AVE
Practice Address - Street 2:STE 203
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1375
Practice Address - Country:US
Practice Address - Phone:845-471-2243
Practice Address - Fax:845-471-2883
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002446213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY480010517OtherPALMETTO GBA RR MC
NY00405261Medicaid
NY00405261Medicaid
NY480010517OtherPALMETTO GBA RR MC
NY480010517OtherPALMETTO GBA RR MC