Provider Demographics
NPI:1609982529
Name:ANREDER, LEWIS SETH (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:SETH
Last Name:ANREDER
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:PO BOX 1555
Mailing Address - Street 2:
Mailing Address - City:QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11959-1555
Mailing Address - Country:US
Mailing Address - Phone:631-653-6000
Mailing Address - Fax:631-653-8310
Practice Address - Street 1:33 MONTAUK HIGHWAY
Practice Address - Street 2:
Practice Address - City:QUOGUE
Practice Address - State:NY
Practice Address - Zip Code:11959
Practice Address - Country:US
Practice Address - Phone:631-653-6000
Practice Address - Fax:631-653-8310
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01031603030Medicaid
NY01031603030Medicaid
NYD38935Medicare UPIN