Healthcare Provider Details

I. General information

NPI: 1386640712
Provider Name (Legal Business Name): GREGORY DAVID LEWISH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LYELL AVE STE 107
ROCHESTER NY
14606-5743
US

IV. Provider business mailing address

2 PELHAM RD
ROCHESTER NY
14610-2519
US

V. Phone/Fax

Practice location:
  • Phone: 585-429-6440
  • Fax: 429-585-6661
Mailing address:
  • Phone: 585-473-4844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number156391-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: