Healthcare Provider Details

I. General information

NPI: 1528047297
Provider Name (Legal Business Name): RACHEL LEWIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 08/23/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 W 86TH ST COLUMBIA.WEST SIDE PEDIATRICS
NEW YORK NY
10024-3616
US

IV. Provider business mailing address

21 W 86TH ST COLUMBIA.WEST SIDE PEDIATRICS
NEW YORK NY
10024-3616
US

V. Phone/Fax

Practice location:
  • Phone: 212-799-2737
  • Fax: 212-799-8150
Mailing address:
  • Phone: 212-799-2737
  • Fax: 212-799-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number218601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: