Healthcare Provider Details

I. General information

NPI: 1962687327
Provider Name (Legal Business Name): LESLEY BROOK LEWIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 COUNTY HOUSE RD
SEWELL NJ
08080-2525
US

IV. Provider business mailing address

211 COUNTY HOUSE RD
SEWELL NJ
08080-2525
US

V. Phone/Fax

Practice location:
  • Phone: 877-823-5230
  • Fax:
Mailing address:
  • Phone: 877-823-5230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MB08760000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS015210
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: