Provider Demographics
NPI:1295210292
Name:JOSE PAUL LOOR DPM LLC
Entity Type:Organization
Organization Name:JOSE PAUL LOOR DPM LLC
Other - Org Name:DELOOR PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:P
Authorized Official - Last Name:LOOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:646-828-8004
Mailing Address - Street 1:115 E 61ST ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8183
Mailing Address - Country:US
Mailing Address - Phone:646-828-8004
Mailing Address - Fax:516-753-9320
Practice Address - Street 1:115 E 61ST ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8183
Practice Address - Country:US
Practice Address - Phone:646-828-8004
Practice Address - Fax:516-753-9320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASC006329OtherPODIATRIST