Provider Demographics
NPI:1528206729
Name:LEWIS, NICHOLE RACQUEL (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:RACQUEL
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MIDLAND AVE
Mailing Address - Street 2:APT. B71
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1409
Mailing Address - Country:US
Mailing Address - Phone:914-720-6198
Mailing Address - Fax:
Practice Address - Street 1:128 ASHFORD AVE
Practice Address - Street 2:CARE OF DOBBS FERRY EMERGENCY MEDICINE, PC
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1924
Practice Address - Country:US
Practice Address - Phone:914-559-1072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261823207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine