Provider Demographics
NPI:1801233226
Name:LLOY E ANDERSON MD, PA
Entity Type:Organization
Organization Name:LLOY E ANDERSON MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-222-0123
Mailing Address - Street 1:44 COURT ST
Mailing Address - Street 2:SUITE# 322
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4405
Mailing Address - Country:US
Mailing Address - Phone:718-222-0123
Mailing Address - Fax:718-222-1039
Practice Address - Street 1:44 COURT ST
Practice Address - Street 2:SUITE# 322
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4405
Practice Address - Country:US
Practice Address - Phone:718-222-0123
Practice Address - Fax:718-222-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181532174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty