Provider Demographics
NPI:1306020102
Name:LEWIS WOLSTEIN DPM PC
Entity Type:Organization
Organization Name:LEWIS WOLSTEIN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM PC
Authorized Official - Phone:718-671-7226
Mailing Address - Street 1:100-1 DEKRUIF PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-2402
Mailing Address - Country:US
Mailing Address - Phone:718-671-7226
Mailing Address - Fax:718-671-7708
Practice Address - Street 1:100 1 DE KRUIF PL
Practice Address - Street 2:FRONT 1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-2402
Practice Address - Country:US
Practice Address - Phone:718-671-7226
Practice Address - Fax:718-671-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00414420Medicaid
NY1314830001Medicare NSC
NYP29711Medicare PIN
NYT50829Medicare PIN