Healthcare Provider Details

I. General information

NPI: 1699482026
Provider Name (Legal Business Name): EDWARD D LEWIS MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

880 WESTFALL RD STE E
ROCHESTER NY
14618-2611
US

IV. Provider business mailing address

880 WESTFALL RD STE E
ROCHESTER NY
14618-2611
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-1421
  • Fax: 585-442-6882
Mailing address:
  • Phone: 585-442-1421
  • Fax: 585-442-6882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD D LEWIS
Title or Position: OWNER
Credential: MD
Phone: 585-442-1421