Provider Demographics
NPI:1679653547
Name:LORUSSO-PESIRI, ANDREA (DC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LORUSSO-PESIRI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 NEW HYDE PARK RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2027
Mailing Address - Country:US
Mailing Address - Phone:516-775-7654
Mailing Address - Fax:516-775-7656
Practice Address - Street 1:1825 NEW HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2027
Practice Address - Country:US
Practice Address - Phone:516-775-7654
Practice Address - Fax:516-775-7656
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX54341Medicare ID - Type Unspecified
NYU34510Medicare UPIN