Provider Demographics
NPI:1558403477
Name:SUSAN LEWIN DPM
Entity Type:Organization
Organization Name:SUSAN LEWIN DPM
Other - Org Name:ACTIVE FOOTCARE PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-445-3445
Mailing Address - Street 1:913 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1629
Mailing Address - Country:US
Mailing Address - Phone:718-445-3445
Mailing Address - Fax:
Practice Address - Street 1:913 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1629
Practice Address - Country:US
Practice Address - Phone:718-445-3445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005630213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02205127Medicaid
NYU77742Medicare UPIN
NY03787Medicare PIN
NY060621Medicare ID - Type Unspecified