Provider Demographics
NPI:1114081239
Name:CONLIN, LORI JEAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:CONLIN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 KNOLLWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-543-7813
Mailing Address - Fax:
Practice Address - Street 1:5316 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2591
Practice Address - Country:US
Practice Address - Phone:316-897-8006
Practice Address - Fax:631-751-0506
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302381363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY90N281Medicare ID - Type Unspecified