Healthcare Provider Details

I. General information

NPI: 1639164635
Provider Name (Legal Business Name): LEWIS NELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 03/29/2025
Certification Date: 03/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 GLADES RD # BC-71
BOCA RATON FL
33431-6496
US

IV. Provider business mailing address

777 GLADES RD # BC-71
BOCA RATON FL
33431-6496
US

V. Phone/Fax

Practice location:
  • Phone: 561-297-0133
  • Fax:
Mailing address:
  • Phone: 561-297-0133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberME171142
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME171142
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: