Healthcare Provider Details

I. General information

NPI: 1487619987
Provider Name (Legal Business Name): PAUL F LEWANDOWSKI D.C., C.C.S.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 ROUTE 50
BURNT HILLS NY
12027-9584
US

IV. Provider business mailing address

1175 EASTERN AVE
CHARLTON NY
12019-2911
US

V. Phone/Fax

Practice location:
  • Phone: 518-399-2225
  • Fax:
Mailing address:
  • Phone: 518-882-5268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX005903-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: