Healthcare Provider Details

I. General information

NPI: 1104790872
Provider Name (Legal Business Name): TIFFANY LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MERCHANTS CONCOURSE
WESTBURY NY
11590-5142
US

IV. Provider business mailing address

27 EMERALD LN N
AMITYVILLE NY
11701-2011
US

V. Phone/Fax

Practice location:
  • Phone: 516-565-6322
  • Fax: 877-717-2778
Mailing address:
  • Phone: 631-480-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number723529-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: