Basic Information
| Provider Information | |||||||||
| NPI: | 1417933706 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | P JEFFREY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 ORCHARD PARK RD | ||||||||
| Address2: | SUITE A105 | ||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142242646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166776000 | ||||||||
| FaxNumber: | 7166776006 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 ORCHARD PARK RD | ||||||||
| Address2: | SUITE A105 | ||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142242646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166776000 | ||||||||
| FaxNumber: | 7166776006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 1768721 | NY | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 040426000202 | 01 | NY | FIDELIS CARE | OTHER | 000510718005 | 01 | NY | BLUE CROSS BLUE SHIELD | OTHER | 01123633 | 05 | NY | MEDICAID | 00020071601 | 01 | NY | UNIVERA HEALTHCARE | OTHER | 0607774 | 01 | NY | INDEPENDENT HEALTH | OTHER |