Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | 010504 | PA |
Y | 111NR0400X | Rehabilitation Chiropractor | 010504 | PA |
NPI | 1265701536 |
---|---|
Provider Name | Dr. Neil Lewis |
First Address | East Stroudsburg, PA 18302-9311 |
Second Address | East Stroudsburg, PA 18301-1307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2011 |
Last Update Date | 15/12/2011 |