Healthcare Provider Details

I. General information

NPI: 1427202464
Provider Name (Legal Business Name): MICHELE LEWIS M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MEADOWLANDS PKWY
SECAUCUS NJ
07094-2977
US

IV. Provider business mailing address

PO BOX 1215
ENGLEWOOD CLIFFS NJ
07632-0215
US

V. Phone/Fax

Practice location:
  • Phone: 201-392-3100
  • Fax: 201-392-3270
Mailing address:
  • Phone: 201-871-6002
  • Fax: 201-871-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA05785100
License Number StateNJ

VIII. Authorized Official

Name: MICHELE LEWIS
Title or Position: ANESTHESIOLOGIST
Credential: M.D.
Phone: 201-871-6002