Provider Demographics
NPI:1568984441
Name:LORTZ, MICHELE ANN (EDM)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ANN
Last Name:LORTZ
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 BAYARD ST.
Mailing Address - Street 2:PO BOX 696
Mailing Address - City:PORT EWEN
Mailing Address - State:NY
Mailing Address - Zip Code:12466
Mailing Address - Country:US
Mailing Address - Phone:845-224-7519
Mailing Address - Fax:
Practice Address - Street 1:4184 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:WEST CAMP
Practice Address - State:NY
Practice Address - Zip Code:12490
Practice Address - Country:US
Practice Address - Phone:845-247-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency