Provider Demographics
NPI:1043392517
Name:BUSCH, LORI (DO)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BUSCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:LAMBROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DEO
Mailing Address - Street 1:259 1ST ST
Mailing Address - Street 2:WINTHROP 2, ROOM 291
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3957
Mailing Address - Country:US
Mailing Address - Phone:516-663-8693
Mailing Address - Fax:516-663-4532
Practice Address - Street 1:259 1 STREET
Practice Address - Street 2:WINTHROP 2, ROOM 291
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:516-663-8693
Practice Address - Fax:516-663-4532
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine