Provider Demographics
NPI:1740828367
Name:LEWIS, KIMBERLY J (MS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:J
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3832 CORY CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NY
Mailing Address - Zip Code:14505-9722
Mailing Address - Country:US
Mailing Address - Phone:315-576-0377
Mailing Address - Fax:
Practice Address - Street 1:3832 CORY CORNERS RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NY
Practice Address - Zip Code:14505-9722
Practice Address - Country:US
Practice Address - Phone:315-576-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty