Healthcare Provider Details

I. General information

NPI: 1811999899
Provider Name (Legal Business Name): LEWIS WOLSTEIN DPM PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DEKRUIF PLACE FRNT 1
BRONX NY
10475
US

IV. Provider business mailing address

100 DEKRUIF PLACE FRNT 1
BRONX NY
10475
US

V. Phone/Fax

Practice location:
  • Phone: 718-671-7226
  • Fax: 718-671-7708
Mailing address:
  • Phone: 718-671-7226
  • Fax: 718-671-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN002582
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: