Provider Demographics
NPI:1174511778
Name:LEWIS, LISA SUZANNE (RPAC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SUZANNE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:SUZANNE
Other - Last Name:VAN LANDSCHOOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPAC
Mailing Address - Street 1:12 BRIARHILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1807
Mailing Address - Country:US
Mailing Address - Phone:716-636-7909
Mailing Address - Fax:
Practice Address - Street 1:4949 HARLEM RD
Practice Address - Street 2:UNIVERSITY ORTHOPAEDICS
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-2500
Practice Address - Country:US
Practice Address - Phone:716-204-3251
Practice Address - Fax:716-891-2032
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006448363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01893672Medicaid
NY006448OtherLICENSE
NY006448OtherLICENSE
NYMV0352776OtherDEA
NYB17181Medicare UPIN