Provider Demographics
NPI:1962826602
Name:JOSE PAUL LOOR DPM PLLC
Entity Type:Organization
Organization Name:JOSE PAUL LOOR DPM PLLC
Other - Org Name:JOSE PAUL LOOR DPM PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LOOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-777-9465
Mailing Address - Street 1:2308 NEWTOWN AVE
Mailing Address - Street 2:APT 2FE
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3009
Mailing Address - Country:US
Mailing Address - Phone:718-777-9465
Mailing Address - Fax:
Practice Address - Street 1:501 5TH AVE
Practice Address - Street 2:SUITE 1108
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6107
Practice Address - Country:US
Practice Address - Phone:718-777-9465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty