Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 25MA08262900 | NJ |
N | 207YS0123X | Facial Plastic Surgeon | A95117 | CA |
NPI | 1700808938 |
---|---|
Provider Name | David Lewis |
First Address | Englewood, NJ 07631-2428 |
Second Address | Englewood, NJ 07631-2428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 26/10/2007 |