Provider Demographics
NPI:1043795396
Name:LEWIS J SIMS DPM P.C.
Entity type:Organization
Organization Name:LEWIS J SIMS DPM P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BERBERICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-471-2243
Mailing Address - Street 1:5 EASTDALE AVE S
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-1955
Mailing Address - Country:US
Mailing Address - Phone:845-471-2243
Mailing Address - Fax:845-471-2883
Practice Address - Street 1:5 EASTDALE AVE S
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-1955
Practice Address - Country:US
Practice Address - Phone:845-471-2243
Practice Address - Fax:845-471-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07918096Medicaid
NY03028773Medicaid
NY04916556Medicaid
NY00877436Medicaid
NY1093207995Medicaid
NY1073569133Medicaid
NY00635227Medicaid
NY07078893Medicaid