=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831159433
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MERYL LEFKOWICZ NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 IRVING AVE SYRACUSE VAMC
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13210-2716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-425-2648
-----------------------------------------------------
Fax | 315-425-2639
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8027 CHATHAM DR
-----------------------------------------------------
City | MANLIUS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13104-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-425-2648
-----------------------------------------------------
Fax | 315-425-2639
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 334116
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------