Healthcare Provider Details

I. General information

NPI: 1962769414
Provider Name (Legal Business Name): AYANNA ELAINE LEWIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 MERRICK RD STE 100
MERRICK NY
11566-4770
US

IV. Provider business mailing address

1 HEALTHY WAY
OCEANSIDE NY
11572-1551
US

V. Phone/Fax

Practice location:
  • Phone: 516-546-5000
  • Fax: 516-546-0596
Mailing address:
  • Phone: 516-632-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME140273
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number298519
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: