NPIMap

Organization Active NPI

Lewiston Village Pediatrics

  • Pediatrics Physician
  • Lewiston, NY
National Provider Identifier
1629177134
Registry record updated Aug 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
131077 Issued in NY
Legal business name
LEWISTON VILLAGE PEDIATRICS
Practice address
733 Center Street
Lewiston, NY 14092
Phone
(716) 754-7337
Fax
(716) 754-2041
NPI assigned
Sep 21, 2006
Last updated
Aug 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Shawn P Ferguson, M.D.NPI 1922071521
Title
President
Phone
(716) 754-7337

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 131077 NY Primary

Addresses

Primary practice location

733 Center Street
Lewiston, NY 14092

Mailing address

733 Center Street
Lewiston, NY 14092
Phone (716) 754-7337

Other identifiers 4

IdentifierTypeStateIssuer
00968483MedicaidNY
01827458MedicaidNY
00586883MedicaidNY
07152689MedicaidNY

National Provider Directory

National Provider Directory

Locations

733 Center St
Lewiston, NY 14092
Phone (716) 754-7337

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470268800000",
    "number": "1629177134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "733 CENTER STREET",
            "city": "LEWISTON",
            "state": "NY",
            "postal_code": "14092",
            "telephone_number": "716-754-7337",
            "fax_number": "716-754-2041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "733 CENTER STREET",
            "city": "LEWISTON",
            "state": "NY",
            "postal_code": "14092",
            "telephone_number": "716-754-7337",
            "fax_number": "716-754-2041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEWISTON VILLAGE PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2016-08-04",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "716-754-7337",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "131077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00968483",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01827458",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00586883",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07152689",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.