Provider Demographics
NPI:1326489881
Name:LEWIS, BRIDGET E (MSED)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:E
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21638 REED RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5048
Mailing Address - Country:US
Mailing Address - Phone:315-786-0677
Mailing Address - Fax:
Practice Address - Street 1:210 COURT ST
Practice Address - Street 2:SUITE 9
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4546
Practice Address - Country:US
Practice Address - Phone:315-786-0677
Practice Address - Fax:315-836-3782
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY666387121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist