Provider Demographics
NPI:1396840971
Name:LEWICK, ANJANI GHATALIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:ANJANI
Middle Name:GHATALIA
Last Name:LEWICK
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-4502
Mailing Address - Country:US
Mailing Address - Phone:845-489-0411
Mailing Address - Fax:
Practice Address - Street 1:95 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6148
Practice Address - Country:US
Practice Address - Phone:203-739-7029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT180313163W00000X
CT9766363LF0000X
NY489-156363LF0000X
NYF333612-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse