Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 131715 | NY |
N | 2080P0201X | Pediatric Allergist | 131715 | NY |
NPI | 1093714230 |
---|---|
Provider Name | Fred H. Lewis |
First Address | Olean, NY 14760-1500 |
Second Address | Olean, NY 14760-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 16/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00010264202 | UNIVERA (01) | |
000500015002 | BC/BS (01) | |
00762327 | (05) | NY |
0206516 | IHA (01) | |
040426004096 | FIDELIS (01) | |
E35941 | (02) | |
E35941 | (02) | NY |