Provider Demographics
NPI:1750470787
Name:LEWANDOWSKI, PAUL MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:LEWANDOWSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1148
Mailing Address - Country:US
Mailing Address - Phone:973-402-1331
Mailing Address - Fax:973-402-9667
Practice Address - Street 1:338 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1148
Practice Address - Country:US
Practice Address - Phone:973-402-1331
Practice Address - Fax:973-402-9667
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02884111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP45743Medicare UPIN
NJ536615Medicare PIN
NJLA860729Medicare ID - Type UnspecifiedMEDICARE #