MEDICARE: DR. LISA LEWIS ND, LAC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	25MZ00091500	NJ
2	175F00000X	Naturopath	ND-438	CA

General Provider Information

NPI Number	:	1841631512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA LEWIS ND, LAC.

Provider Business Mailing Address
First Line	:	71 BOSTON ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-3436
Country	:	US
Telephone Number	:	973-486-0148
Fax Number	:	973-486-0838

Provider Business Practice Location Address
First Line	:	71 BOSTON ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-3436
Country	:	US
Telephone Number	:	973-486-0148
Fax Number	:	973-486-0838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2013
Last Update Date	:	07/10/2013

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