Provider Demographics
NPI:1386755015
Name:LEWIS MANTELL, LAURA ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANNE
Last Name:LEWIS MANTELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1430 2ND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3313
Mailing Address - Country:US
Mailing Address - Phone:212-734-2902
Mailing Address - Fax:212-734-9195
Practice Address - Street 1:1430 2ND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3313
Practice Address - Country:US
Practice Address - Phone:212-734-2902
Practice Address - Fax:212-734-9195
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY167828 1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133678535OtherFEDERAL TAX ID
NY24E321Medicare ID - Type Unspecified
NYA61489Medicare UPIN