Provider Demographics
NPI:1366691560
Name:LEWIS, KAREN MICHELE
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MICHELE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SIOUX PL
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1914
Mailing Address - Country:US
Mailing Address - Phone:917-664-4082
Mailing Address - Fax:631-385-1898
Practice Address - Street 1:2 SIOUX PL
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1914
Practice Address - Country:US
Practice Address - Phone:917-664-4082
Practice Address - Fax:631-385-1898
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications