Provider Demographics
NPI:1699162214
Name:LEWIL SERVICES INC.
Entity type:Organization
Organization Name:LEWIL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MS
Authorized Official - First Name:LORENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:917-532-8267
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4540
Mailing Address - Country:US
Mailing Address - Phone:917-532-8267
Mailing Address - Fax:
Practice Address - Street 1:273 MEDEA WAY
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4540
Practice Address - Country:US
Practice Address - Phone:917-532-8267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1023370889Medicaid