Provider Demographics
NPI:1164595054
Name:LEWIS, DAWN E
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:E
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DAWN
Other - Middle Name:E
Other - Last Name:BARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 SUNRISE HWY
Mailing Address - Street 2:BUILDING 300, SUITE 403
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-1001
Mailing Address - Country:US
Mailing Address - Phone:631-854-0164
Mailing Address - Fax:
Practice Address - Street 1:3500 SUNRISE HWY
Practice Address - Street 2:BUILDING 300, SUITE 403
Practice Address - City:GREAT RIVER
Practice Address - State:NY
Practice Address - Zip Code:11739-1001
Practice Address - Country:US
Practice Address - Phone:631-854-0164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY116000464OtherTAX ID