Provider Demographics
NPI:1649743204
Name:LEWIS, GEORGE KENNETH JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:KENNETH
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 PINEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3313
Mailing Address - Country:US
Mailing Address - Phone:978-604-1246
Mailing Address - Fax:
Practice Address - Street 1:56 QUARRY RD
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4874
Practice Address - Country:US
Practice Address - Phone:888-202-9831
Practice Address - Fax:888-202-9831
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist