Basic Information
| Provider Information | |||||||||
| NPI: | 1306886361 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANE | ||||||||
| FirstName: | LEWIS | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5200 | ||||||||
| Address2: | |||||||||
| City: | MANHASSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110305200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167232663 | ||||||||
| FaxNumber: | 5163257190 | ||||||||
| Practice Location | |||||||||
| Address1: | 611 NORTHERN BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110215207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167232663 | ||||||||
| FaxNumber: | 5163257190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 08/01/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0106X | 124329 | NY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207X00000X | 124329 | NY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200008041 | 01 | NY | MEDICARE ID | OTHER | AS1071 | 01 | OXFORD | OTHER |