Provider Demographics
NPI:1174809537
Name:LEWIN, VIRGINIA J (RN)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:J
Last Name:LEWIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:S JAMESPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11970-0186
Mailing Address - Country:US
Mailing Address - Phone:631-722-4205
Mailing Address - Fax:631-727-7008
Practice Address - Street 1:165 OLIVER ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-6216
Practice Address - Country:US
Practice Address - Phone:631-727-7006
Practice Address - Fax:631-727-7008
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253954163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY253954OtherRN LICENSE