Provider Demographics
NPI:1295755171
Name:LEWIN, SUSAN E (DPM)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:LEWIN
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 1:913 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1629
Mailing Address - Country:US
Mailing Address - Phone:917-930-7479
Mailing Address - Fax:516-569-3294
Practice Address - Street 1:2146 BEVERLEY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5406
Practice Address - Country:US
Practice Address - Phone:718-210-3296
Practice Address - Fax:877-868-8633
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN005630213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02519726Medicaid
NY02205127Medicaid
NY02205127Medicaid
NYU77742Medicare UPIN
NYPQW201Medicare ID - Type UnspecifiedGROUP PROVIDER #
NYPB3381Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
NY0545IIMedicare PIN