Healthcare Provider Details

I. General information

NPI: 1750566329
Provider Name (Legal Business Name): 540 EAST 43RD STREET PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 E 43RD ST
BROOKLYN NY
11203-5716
US

IV. Provider business mailing address

540 E 43RD ST
BROOKLYN NY
11203-5716
US

V. Phone/Fax

Practice location:
  • Phone: 718-451-1206
  • Fax: 718-629-2427
Mailing address:
  • Phone: 718-451-1206
  • Fax: 718-629-2427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberNOO5983
License Number StateNY

VIII. Authorized Official

Name: DR. SHAUNA M LEWIS
Title or Position: PRESIDENT
Credential: DPM
Phone: 718-451-1206