Provider Demographics
NPI:1861404055
Name:LEWIN, BERNARD DELANO (MD)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:DELANO
Last Name:LEWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8791 193RD STREET
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2934
Mailing Address - Country:US
Mailing Address - Phone:718-740-5440
Mailing Address - Fax:718-740-5447
Practice Address - Street 1:8791 193RD STREET
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11432-2934
Practice Address - Country:US
Practice Address - Phone:718-740-5440
Practice Address - Fax:718-740-5447
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125160207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C34753Medicare UPIN