Provider Demographics
NPI:1992856710
Name:LEW, DOLORES JEAN SR
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:JEAN
Last Name:LEW
Suffix:SR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CONVENT RD
Mailing Address - Street 2:KELLIGAR HOUSE
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6923
Mailing Address - Country:US
Mailing Address - Phone:973-290-5324
Mailing Address - Fax:
Practice Address - Street 1:703 MAIN ST.
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503
Practice Address - Country:US
Practice Address - Phone:973-754-2240
Practice Address - Fax:973-754-2244
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP000109363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ950053Medicare ID - Type Unspecified