Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 244669 | NY |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 244669 | NY |
NPI | 1215275789 |
---|---|
Provider Name | Dr. Luella Toni Lewis |
First Address | New York, NY 10036-6902 |
Second Address | New York, NY 10036-6902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2013 |
Last Update Date | 17/01/2013 |