Provider Demographics
NPI:1548000524
Name:LEWIS, MONETA LAVERN
Entity type:Individual
Prefix:
First Name:MONETA
Middle Name:LAVERN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MCKAY AVE PH
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1004
Mailing Address - Country:US
Mailing Address - Phone:347-645-5221
Mailing Address - Fax:
Practice Address - Street 1:345 SAINT ANNS AVE APT 7W
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-2385
Practice Address - Country:US
Practice Address - Phone:347-645-5221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula