Provider Demographics
NPI:1427296771
Name:LEWIS, MARTIN CLAY (MED, MSN, APRN-BC)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:CLAY
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MED, MSN, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 VAN LIEUS RD
Mailing Address - Street 2:
Mailing Address - City:RINGOES
Mailing Address - State:NJ
Mailing Address - Zip Code:08551-1314
Mailing Address - Country:US
Mailing Address - Phone:609-552-5182
Mailing Address - Fax:609-552-5183
Practice Address - Street 1:47 VAN LIEUS RD
Practice Address - Street 2:
Practice Address - City:RINGOES
Practice Address - State:NJ
Practice Address - Zip Code:08551-1314
Practice Address - Country:US
Practice Address - Phone:609-552-5182
Practice Address - Fax:609-552-5183
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-24
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00172800173000000X, 174400000X
NJ29NJ001172800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
No174400000XOther Service ProvidersSpecialist
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1427296771OtherNPI