Provider Demographics
NPI:1689208803
Name:KILO, LAWRENCE B
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:B
Last Name:KILO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 COLDEN ST APT 9P
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3942
Mailing Address - Country:US
Mailing Address - Phone:718-564-5300
Mailing Address - Fax:
Practice Address - Street 1:4255 COLDEN ST APT 9P
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3942
Practice Address - Country:US
Practice Address - Phone:718-564-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY584415163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse