Provider Demographics
NPI:1235667809
Name:PENTECOST-LEWIS, HEAVEN ANN-MARIE (MS)
Entity Type:Individual
Prefix:
First Name:HEAVEN
Middle Name:ANN-MARIE
Last Name:PENTECOST-LEWIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GAYLORD ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13904-1608
Mailing Address - Country:US
Mailing Address - Phone:607-651-0994
Mailing Address - Fax:
Practice Address - Street 1:4104 VESTAL RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3500
Practice Address - Country:US
Practice Address - Phone:607-235-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist