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General NPI Number Information
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NPI Number | 1417285347
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Entity Type | Individual
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Provider Name | LEWIS JOHN COLLINS ATC
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Gender | Male
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Dates
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Enumeration Date | 12/04/2009
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Last Update Date | 12/04/2009
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Provider Practice Location Address
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Address Line | 450 CLARKSON AVE BOX #30
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City | BROOKLYN
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State | NY
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Zip | 11203-2012
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Country | US
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Telephone | 718-221-5215
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Fax |
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Provider Business Mailing Address
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Address Line | 450 CLARKSON AVE BOX #30
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City | BROOKLYN
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State | NY
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Zip | 11203-2012
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Country | US
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Telephone | 718-221-5215
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number | 521821
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 67001723
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License Number State | NY
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