Healthcare Provider Details

I. General information

NPI: 1871584730
Provider Name (Legal Business Name): NEW MEXICO CLINICAL RESEARCH & OSTEOPOROSIS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OAK ST NE
ALBUQUERQUE NM
87106-4725
US

IV. Provider business mailing address

300 OAK ST NE
ALBUQUERQUE NM
87106-4725
US

V. Phone/Fax

Practice location:
  • Phone: 505-855-5525
  • Fax: 505-884-4006
Mailing address:
  • Phone: 505-855-5525
  • Fax: 505-884-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. E MICHAEL LEWIECKI
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 505-855-5525