Provider Demographics
NPI:1811194293
Name:CODNER, LORNER PATRICIA
Entity Type:Individual
Prefix:
First Name:LORNER
Middle Name:PATRICIA
Last Name:CODNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 GARDNERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:10958
Mailing Address - Country:US
Mailing Address - Phone:845-355-3175
Mailing Address - Fax:
Practice Address - Street 1:205 GARDNERVILLE RD
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:10958
Practice Address - Country:US
Practice Address - Phone:845-355-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223695-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02815323Medicaid