Provider Demographics
NPI:1588692909
Name:LEWIS, FRIEDA E (MD)
Entity type:Individual
Prefix:
First Name:FRIEDA
Middle Name:E
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 NEWTON SPARTA RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860
Mailing Address - Country:US
Mailing Address - Phone:973-383-8555
Mailing Address - Fax:973-383-8424
Practice Address - Street 1:135 NEWTON SPARTA RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860
Practice Address - Country:US
Practice Address - Phone:973-383-8555
Practice Address - Fax:973-383-8424
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07673700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083529CGROtherMEDICARE
NJ222903580015OtherST BARNABAS HEALTH
NJ2K7922OtherHEALTH NET PHS
NJ0049760Medicaid
NJ5396467001OtherCIGNA HMO
NJ5396467OtherCIGNA COMED
NJ2K7922OtherHEALTH NET PHS
NJI16827Medicare UPIN