Provider Demographics
NPI:1982682266
Name:LEWIS, JEAN O (NP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:O
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 INTERVALE RD
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1501
Mailing Address - Country:US
Mailing Address - Phone:631-444-1519
Mailing Address - Fax:631-444-1543
Practice Address - Street 1:DEPT OF OPHTHALMOLOGY
Practice Address - Street 2:SUNY STONY BROOK
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-1519
Practice Address - Fax:631-444-1543
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF301141-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner