Basic Information
| Provider Information | |||||||||
| NPI: | 1710111786 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 863 FISKE RD | ||||||||
| Address2: | |||||||||
| City: | WEST CHAZY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129923425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185613803 | ||||||||
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| Practice Location | |||||||||
| Address1: | 863 FISKE RD | ||||||||
| Address2: | |||||||||
| City: | WEST CHAZY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129923425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185613803 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2009 | ||||||||
| LastUpdateDate: | 05/06/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 019048 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.