Provider Demographics
NPI:1285036830
Name:LOZANO, MARIE JAMIE
Entity Type:Individual
Prefix:
First Name:MARIE JAMIE
Middle Name:
Last Name:LOZANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5127 CODWISE PL APT 2B
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4175
Mailing Address - Country:US
Mailing Address - Phone:646-267-2198
Mailing Address - Fax:
Practice Address - Street 1:5127 CODWISE PL APT 2B
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4175
Practice Address - Country:US
Practice Address - Phone:646-267-2198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist