Provider Demographics
NPI:1164615605
Name:ANDERSON, LORRAINE E (NP)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 YORK AVE
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY C-7
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:212-639-6920
Mailing Address - Fax:212-639-4030
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY C-7
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:212-639-6920
Practice Address - Fax:212-639-4030
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-18
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301254-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health