Provider Demographics
NPI:1841631512
Name:LEWIS, LISA (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-3436
Mailing Address - Country:US
Mailing Address - Phone:973-486-0148
Mailing Address - Fax:973-486-0838
Practice Address - Street 1:71 BOSTON ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-3436
Practice Address - Country:US
Practice Address - Phone:973-486-0148
Practice Address - Fax:973-486-0838
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00091500171100000X
CAND-438175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath