Provider Demographics
NPI:1255453445
Name:LEWIS, JEFFREY IRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:IRA
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16303 HORACE HARDING EXPY
Mailing Address - Street 2:SUITE #302
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1449
Mailing Address - Country:US
Mailing Address - Phone:718-445-7920
Mailing Address - Fax:718-445-7794
Practice Address - Street 1:16303 HORACE HARDING EXPY
Practice Address - Street 2:SUITE #302
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-1449
Practice Address - Country:US
Practice Address - Phone:718-445-7920
Practice Address - Fax:718-445-7794
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008971103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical