Provider Demographics
NPI:1609961176
Name:LEWIS, THOMAS PETER (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PETER
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:973-656-6280
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:346 SOUTH AVENUE
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1325
Practice Address - Country:US
Practice Address - Phone:908-889-4700
Practice Address - Fax:908-889-0867
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03638800207R00000X
NY138968-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54724Medicare UPIN