Provider Demographics
NPI:1396006177
Name:LEW, MARTHA HAERYONG (MSED, NYS SPED CERT)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:HAERYONG
Last Name:LEW
Suffix:
Gender:F
Credentials:MSED, NYS SPED CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105-39 63RD ROAD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-544-1987
Mailing Address - Fax:
Practice Address - Street 1:10539 63RD RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1348
Practice Address - Country:US
Practice Address - Phone:718-544-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY686410174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist