Provider Demographics
NPI:1336305788
Name:NEUSHOTZ, LORI (DNP, NPP, PMHCNS-BC,)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:NEUSHOTZ
Suffix:
Gender:F
Credentials:DNP, NPP, PMHCNS-BC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E 90TH ST APT 4D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5195
Mailing Address - Country:US
Mailing Address - Phone:212-534-3671
Mailing Address - Fax:212-534-3671
Practice Address - Street 1:469 FASHION AVE
Practice Address - Street 2:SUITE 732
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7605
Practice Address - Country:US
Practice Address - Phone:917-767-1958
Practice Address - Fax:212-534-3671
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400200363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
217282OtherHEALTHNET