Provider Demographics
NPI:1407844707
Name:LLORENS, JOSE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:E
Last Name:LLORENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 CHAPIN TER
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1706
Mailing Address - Country:US
Mailing Address - Phone:413-733-6595
Mailing Address - Fax:413-733-4544
Practice Address - Street 1:84 CHAPIN TER
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1706
Practice Address - Country:US
Practice Address - Phone:413-733-6595
Practice Address - Fax:413-733-4544
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53947208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6186882Medicaid
MA6186882Medicaid