Provider Demographics
NPI:1669474995
Name:DENNIS, LESTER NEIL (DPM)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:NEIL
Last Name:DENNIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-2703
Mailing Address - Country:US
Mailing Address - Phone:914-381-4321
Mailing Address - Fax:
Practice Address - Street 1:102 NORMAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-2934
Practice Address - Country:US
Practice Address - Phone:718-389-4404
Practice Address - Fax:718-389-5317
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002375213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00414535Medicaid
4004430001Medicare NSC
P26641Medicare ID - Type Unspecified
NY00414535Medicaid