Provider Demographics
NPI:1801816921
Name:LEWIS, MOSHE (MD)
Entity Type:Individual
Prefix:
First Name:MOSHE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 VALENCIA ST STE 703
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4415
Mailing Address - Country:US
Mailing Address - Phone:415-642-0707
Mailing Address - Fax:415-648-7988
Practice Address - Street 1:1580 VALENCIA ST
Practice Address - Street 2:SUITE 703
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4423
Practice Address - Country:US
Practice Address - Phone:415-642-0707
Practice Address - Fax:415-648-7988
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90204208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A902042Medicare PIN
CAI 47914Medicare UPIN