Healthcare Provider Details

I. General information

NPI: 1366362493
Provider Name (Legal Business Name): EBBENY JEWEL LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CHAZ WAY
FAIRFIELD NJ
07004-3610
US

IV. Provider business mailing address

7 CHAZ WAY
FAIRFIELD NJ
07004-3610
US

V. Phone/Fax

Practice location:
  • Phone: 914-967-5879
  • Fax:
Mailing address:
  • Phone: 914-967-5879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: