Provider Demographics
NPI:1346453040
Name:LAFOREST, LIONEL (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:LIONEL
Middle Name:
Last Name:LAFOREST
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 MARKET LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON CORNERS
Mailing Address - State:NY
Mailing Address - Zip Code:12514-2348
Mailing Address - Country:US
Mailing Address - Phone:914-489-1954
Mailing Address - Fax:
Practice Address - Street 1:288 MARKET LN
Practice Address - Street 2:
Practice Address - City:CLINTON CORNERS
Practice Address - State:NY
Practice Address - Zip Code:12514-2348
Practice Address - Country:US
Practice Address - Phone:914-489-1954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant