Provider Demographics
NPI:1417933706
Name:LEWIS, P JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:P JEFFREY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 ORCHARD PARK RD
Mailing Address - Street 2:SUITE A105
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2646
Mailing Address - Country:US
Mailing Address - Phone:716-677-6000
Mailing Address - Fax:716-677-6006
Practice Address - Street 1:550 ORCHARD PARK RD
Practice Address - Street 2:SUITE A105
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2646
Practice Address - Country:US
Practice Address - Phone:716-677-6000
Practice Address - Fax:716-677-6006
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1768721207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040426000202OtherFIDELIS CARE
NY000510718005OtherBLUE CROSS BLUE SHIELD
NY01123633Medicaid
NY00020071601OtherUNIVERA HEALTHCARE
NY0607774OtherINDEPENDENT HEALTH
NY0607774OtherINDEPENDENT HEALTH
11984BMedicare ID - Type Unspecified