Provider Demographics
NPI:1992861728
Name:WITTY-LEWIS, COSETTE ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:COSETTE
Middle Name:ANNE
Last Name:WITTY-LEWIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1056
Mailing Address - Country:US
Mailing Address - Phone:315-769-4200
Mailing Address - Fax:
Practice Address - Street 1:10 STATE HIGHWAY 37B
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-3142
Practice Address - Country:US
Practice Address - Phone:315-769-4340
Practice Address - Fax:315-769-4675
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004525363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03372598Medicaid
NY004525OtherLICENSE #
NYJ400179835Medicare PIN