Provider Demographics
NPI:1740343847
Name:JASSEY, LEWIS K (DO)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:K
Last Name:JASSEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:BELLMORE MERRICK MEDICAL PC
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710
Mailing Address - Country:US
Mailing Address - Phone:516-409-8800
Mailing Address - Fax:516-409-4921
Practice Address - Street 1:2016 NEWBRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710
Practice Address - Country:US
Practice Address - Phone:516-409-8800
Practice Address - Fax:516-409-4921
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY206951208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG70503Medicare UPIN