Provider Demographics
NPI:1972915577
Name:REGIS, LYDIA (DPM)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:
Last Name:REGIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 E 17TH ST
Mailing Address - Street 2:APT 3A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6063
Mailing Address - Country:US
Mailing Address - Phone:516-605-8332
Mailing Address - Fax:
Practice Address - Street 1:1503 GRAVESEND NECK RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4428
Practice Address - Country:US
Practice Address - Phone:516-605-8332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-30
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006763213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery