Provider Demographics
NPI:1437102571
Name:ATTAS, LEWIS M (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:M
Last Name:ATTAS
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 1:350 ENGLE ST
Mailing Address - Street 2:1ST FLOOR BERRIE BUILDING
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1808
Mailing Address - Country:US
Mailing Address - Phone:201-568-5250
Mailing Address - Fax:201-568-5096
Practice Address - Street 1:350 ENGLE ST
Practice Address - Street 2:1ST FLOOR BERRIE BUILDING
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1808
Practice Address - Country:US
Practice Address - Phone:201-568-5250
Practice Address - Fax:201-568-5096
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0512330174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0796506Medicaid
NJE13390Medicare UPIN
NJ559405CBVMedicare ID - Type Unspecified