Provider Demographics
NPI:1639179294
Name:LEWIS J SIMS DPM P.C.
Entity Type:Organization
Organization Name:LEWIS J SIMS DPM P.C.
Other - Org Name:SIMS AND ASSOCIATES PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-471-2243
Mailing Address - Street 1:19 BAKER AVENUE SUITE 203
Mailing Address - Street 2:SUITE 203
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-471-2243
Mailing Address - Fax:845-471-2883
Practice Address - Street 1:19 BAKER AVE STE 203
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1375
Practice Address - Country:US
Practice Address - Phone:845-471-2243
Practice Address - Fax:845-471-2883
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEWIS J. SIMS DPM P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-26
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002446213E00000X
NY213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCF7210OtherPALMETTO GBA - RR MEDICAR
NY02461521Medicaid
NY02461521Medicaid
NY0693580001Medicare NSC
NYCF7210OtherPALMETTO GBA - RR MEDICAR