Provider Demographics
NPI:1891829289
Name:LEW, DAVID (LAC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:LEW
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E 55TH ST
Mailing Address - Street 2:6D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4030
Mailing Address - Country:US
Mailing Address - Phone:212-579-0880
Mailing Address - Fax:
Practice Address - Street 1:141 E 55TH ST
Practice Address - Street 2:6D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4030
Practice Address - Country:US
Practice Address - Phone:212-579-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000916-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist