Healthcare Provider Details

I. General information

NPI: 1700808938
Provider Name (Legal Business Name): DAVID LEWIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 ENGLE ST STE 101
ENGLEWOOD NJ
07631-2428
US

IV. Provider business mailing address

216 ENGLE ST STE 101
ENGLEWOOD NJ
07631-2428
US

V. Phone/Fax

Practice location:
  • Phone: 201-816-9800
  • Fax:
Mailing address:
  • Phone: 201-816-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA95117
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number25MA08262900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: