Provider Demographics
NPI:1811999899
Name:WOLSTEIN, LEWIS (DPM PC)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:
Last Name:WOLSTEIN
Suffix:
Gender:M
Credentials:DPM PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DEKRUIF PLACE
Mailing Address - Street 2:FRNT 1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475
Mailing Address - Country:US
Mailing Address - Phone:718-671-7226
Mailing Address - Fax:718-671-7708
Practice Address - Street 1:100 DEKRUIF PLACE
Practice Address - Street 2:FRNT 1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475
Practice Address - Country:US
Practice Address - Phone:718-671-7226
Practice Address - Fax:718-671-7708
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002582213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00414420Medicaid
T50829Medicare UPIN
NY00414420Medicaid