Healthcare Provider Details

I. General information

NPI: 1417933706
Provider Name (Legal Business Name): P JEFFREY LEWIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 ORCHARD PARK RD SUITE A105
WEST SENECA NY
14224-2646
US

IV. Provider business mailing address

550 ORCHARD PARK RD SUITE A105
WEST SENECA NY
14224-2646
US

V. Phone/Fax

Practice location:
  • Phone: 716-677-6000
  • Fax: 716-677-6006
Mailing address:
  • Phone: 716-677-6000
  • Fax: 716-677-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number1768721
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: