Provider Demographics
NPI:1073654950
Name:ALL AGES MEDICAL CARE, PLLC
Entity Type:Organization
Organization Name:ALL AGES MEDICAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LORAH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:845-535-3007
Mailing Address - Street 1:2 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1965
Mailing Address - Country:US
Mailing Address - Phone:845-535-3007
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PARK DR
Practice Address - Street 2:SUITE 5
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1965
Practice Address - Country:US
Practice Address - Phone:845-535-3007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2067871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG66736Medicare UPIN