Healthcare Provider Details

I. General information

NPI: 1871531301
Provider Name (Legal Business Name): LEWIS W BRINDIS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 STRAWBERRY LN
CLAYTON NY
13624-1409
US

IV. Provider business mailing address

909 STRAWBERRY LN
CLAYTON NY
13624-1409
US

V. Phone/Fax

Practice location:
  • Phone: 315-686-2094
  • Fax: 315-686-2821
Mailing address:
  • Phone: 315-686-2094
  • Fax: 315-686-2821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000974
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: