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General NPI Number Information
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NPI Number | 1427107531
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Entity Type | Individual
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Provider Name | TARA MARIE LEWIS N.P.
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Gender | Female
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 BELLE TERRE RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1928
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Country | US
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Telephone | 631-474-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 6 WINDING WOOD CT
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City | MOUNT SINAI
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State | NY
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Zip | 11766-3319
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Country | US
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Telephone | 631-331-3652
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | F381695
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License Number State | NY
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