Provider Demographics
NPI:1639299118
Name:D'ANDREA, LORI MICHELLE (PA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MICHELLE
Last Name:D'ANDREA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:187 MILLBURN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1847
Mailing Address - Country:US
Mailing Address - Phone:973-467-1466
Mailing Address - Fax:973-467-1422
Practice Address - Street 1:187 MILLBURN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1847
Practice Address - Country:US
Practice Address - Phone:973-467-1466
Practice Address - Fax:973-467-1422
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2013-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00163300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant