Provider Demographics
NPI:1982629911
Name:DILORENZO, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DILORENZO
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 1:5 CLARENDON PL
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2417
Mailing Address - Country:US
Mailing Address - Phone:914-725-4806
Mailing Address - Fax:914-725-4806
Practice Address - Street 1:5 CLARENDON PL
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-2417
Practice Address - Country:US
Practice Address - Phone:914-686-0010
Practice Address - Fax:914-686-0206
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQQ1762Medicare PIN