Provider Demographics
NPI:1275378119
Name:LEWIS, GREGORY DAVID (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:DAVID
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 E JERSEY ST.
Mailing Address - Street 2:MONASTERY BLDG
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07206
Mailing Address - Country:US
Mailing Address - Phone:908-994-7207
Mailing Address - Fax:908-994-7503
Practice Address - Street 1:655 E JERSEY ST.
Practice Address - Street 2:MONASTERY BLDG
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07206
Practice Address - Country:US
Practice Address - Phone:908-994-7207
Practice Address - Fax:908-994-7503
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program