Provider Demographics
NPI:1518722867
Name:LORA, HENNESY
Entity Type:Individual
Prefix:
First Name:HENNESY
Middle Name:
Last Name:LORA
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 1:1450 VYSE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-1658
Mailing Address - Country:US
Mailing Address - Phone:646-842-6065
Mailing Address - Fax:
Practice Address - Street 1:1450 VYSE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-1658
Practice Address - Country:US
Practice Address - Phone:646-842-6065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker