Provider Demographics
NPI:1699857888
Name:LEWIS, JACQUELINE MARGARET (MD,)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARGARET
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ORCHARD PL
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-3510
Mailing Address - Country:US
Mailing Address - Phone:914-576-7337
Mailing Address - Fax:914-576-7337
Practice Address - Street 1:7601 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3207
Practice Address - Country:US
Practice Address - Phone:718-745-0623
Practice Address - Fax:718-745-8091
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195388207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG24363Medicare UPIN
NY38B152Medicare ID - Type Unspecified