Provider Demographics
NPI:1720193451
Name:BAERINGER, LEWIS ROSS (DPT)
Entity Type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:ROSS
Last Name:BAERINGER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LEVER PL
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3703
Mailing Address - Country:US
Mailing Address - Phone:516-938-0955
Mailing Address - Fax:
Practice Address - Street 1:218 FULTON ST APT 1C
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2541
Practice Address - Country:US
Practice Address - Phone:516-694-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020417-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist