Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 192541 | NY |
NPI | 1104983592 |
---|---|
Provider Name | Cynthia Lewis |
First Address | Bronx, NY 10457 |
Second Address | Bronx, NY 10451 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01726287 | (05) | NY |