Provider Demographics
NPI:1972706653
Name:JACQUELINE M LEWIS, MDPC
Entity Type:Organization
Organization Name:JACQUELINE M LEWIS, MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-576-7337
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:EASC OF BAYRIDGE
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:718-745-7749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195388207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG24363Medicare UPIN
NY38B153Medicare ID - Type Unspecified