Provider Demographics
NPI:1457038671
Name:LEWIS, JONATHAN JOSEPH (MD, PHD)
Entity Type:Individual
Prefix:PROF
First Name:JONATHAN
Middle Name:JOSEPH
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HILLANDALE RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5405
Mailing Address - Country:US
Mailing Address - Phone:646-709-1005
Mailing Address - Fax:
Practice Address - Street 1:125 HILLANDALE RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5405
Practice Address - Country:US
Practice Address - Phone:646-709-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1891802086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology