Healthcare Provider Details

I. General information

NPI: 1104983592
Provider Name (Legal Business Name): CYNTHIA LEWIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/09/2025
Certification Date: 08/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 LYONS AVE FL 1
NEWARK NJ
07112-2016
US

IV. Provider business mailing address

1650 SELWYN AVENUE PEDIATRICS SIXTH FLOOR
BRONX NY
10457
US

V. Phone/Fax

Practice location:
  • Phone: 973-926-7428
  • Fax:
Mailing address:
  • Phone: 718-838-1045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number192541
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA11519000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: