Healthcare Provider Details

I. General information

NPI: 1699857888
Provider Name (Legal Business Name): JACQUELINE MARGARET LEWIS M.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 4TH AVE
BROOKLYN NY
11209-3207
US

IV. Provider business mailing address

7 ORCHARD PL
NEW ROCHELLE NY
10801-3510
US

V. Phone/Fax

Practice location:
  • Phone: 718-745-0623
  • Fax: 718-745-8091
Mailing address:
  • Phone: 914-576-7337
  • Fax: 914-576-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number195388
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: