Provider Demographics
NPI:1487722922
Name:LEWIS, JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
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 1:2308 30TH AVE
Mailing Address - Street 2:FIFTH FLOOR
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3397
Mailing Address - Country:US
Mailing Address - Phone:718-626-1810
Mailing Address - Fax:718-303-7093
Practice Address - Street 1:2308 30TH AVE
Practice Address - Street 2:FIFTH FLOOR
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3397
Practice Address - Country:US
Practice Address - Phone:718-626-1810
Practice Address - Fax:718-626-1811
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097262207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY097262-C40OtherHEALTHFIRST
NY00163662Medicaid
NY097262-A40OtherHEALTHFIRST
NY82100AMedicare ID - Type UnspecifiedGHI MEDICARE
NY00163662Medicaid
NYB78725Medicare UPIN
NY0656441Medicare ID - Type UnspecifiedEMPIRE BCBS MEDICARE