Provider Demographics
NPI:1386776623
Name:GILES, LEWIS PAYNE (PHD)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:PAYNE
Last Name:GILES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 OLD FISH HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BROADALBIN
Mailing Address - State:NY
Mailing Address - Zip Code:12025-2041
Mailing Address - Country:US
Mailing Address - Phone:518-883-3631
Mailing Address - Fax:
Practice Address - Street 1:5 COLD HILL ROAD, SO., STE. 21
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-0415
Practice Address - Country:US
Practice Address - Phone:973-543-5487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00253300103TC0700X
NY014202-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ723959Medicare ID - Type Unspecified