Provider Demographics
NPI:1770562191
Name:LEWIS, LORI L (DPM)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:L
Last Name:LEWIS
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 1:426 MANTUA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2617
Mailing Address - Country:US
Mailing Address - Phone:856-848-7700
Mailing Address - Fax:856-848-7531
Practice Address - Street 1:426 MANTUA AVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-2617
Practice Address - Country:US
Practice Address - Phone:856-848-7700
Practice Address - Fax:856-848-7531
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00189700213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8330701Medicaid
NJ408005Medicare PIN
NJU26647Medicare UPIN