Provider Demographics
NPI:1154333979
Name:MICHAEL P LEWKO MD LLC
Entity Type:Organization
Organization Name:MICHAEL P LEWKO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEWKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-405-5163
Mailing Address - Street 1:871 ALLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1922
Mailing Address - Country:US
Mailing Address - Phone:973-405-5163
Mailing Address - Fax:973-365-8004
Practice Address - Street 1:871 ALLWOOD RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1922
Practice Address - Country:US
Practice Address - Phone:973-405-5163
Practice Address - Fax:973-365-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 50349207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1223801Medicaid
2233854000OtherAMERIHEALTH
NJ1223801Medicaid
NJ102538Medicare PIN