MEDICARE: ELLEN JAY LEWIS PSYCHOANALYST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	102L00000X	Psychoanalyst	000144	NY

General Provider Information

NPI Number	:	1184836116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN JAY LEWIS PSYCHOANALYST

Provider Business Mailing Address
First Line	:	142 MOUNT AIRY RD
Second Line	:
City	:	BERNARDSVILLE
State	:	NJ
Zip	:	07924-2720
Country	:	US
Telephone Number	:	908-766-7586
Fax Number	:	908-766-1994

Provider Business Practice Location Address
First Line	:	142 MOUNT AIRY RD
Second Line	:
City	:	BERNARDSVILLE
State	:	NJ
Zip	:	07924-2720
Country	:	US
Telephone Number	:	908-766-7586
Fax Number	:	908-766-1994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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