Basic Information
| Provider Information | |||||||||
| NPI: | 1104846724 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | RAQUEL | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1008 HAZEL DR | ||||||||
| Address2: | |||||||||
| City: | ENDICOTT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 137602634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6076244467 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1075 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | PLEASANTVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147736901 | ||||||||
| FaxNumber: | 9147698505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 07/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 145622 | CT | N | Nursing Service Providers | Registered Nurse | 163WG0000X | 517976-1 | NY | N | Nursing Service Providers | Registered Nurse | General Practice | 363L00000X | 7304 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LC1500X | 320051 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Community Health | 363LP0808X | 401200 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.