=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417639618
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONAMAR LEWIS NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2023
-----------------------------------------------------
Last Update Date | 08/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 HOSPITAL RD
-----------------------------------------------------
City | PATCHOGUE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11772-4870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-880-8555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 HOSPITAL RD
-----------------------------------------------------
City | PATCHOGUE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11772-4870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 311451
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------