Provider Demographics
NPI:1992056428
Name:LEWIS, CHARLES E (LPN)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 28TH ST
Mailing Address - Street 2:B
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3475
Mailing Address - Country:US
Mailing Address - Phone:516-857-5192
Mailing Address - Fax:
Practice Address - Street 1:3322 28TH ST
Practice Address - Street 2:B
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-3475
Practice Address - Country:US
Practice Address - Phone:516-857-5192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310095314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility