Provider Demographics
NPI:1003258633
Name:VOPAT, LORNA A (MSED)
Entity type:Individual
Prefix:MS
First Name:LORNA
Middle Name:A
Last Name:VOPAT
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MRS
Other - First Name:LORNA
Other - Middle Name:A
Other - Last Name:MATTIMORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSED
Mailing Address - Street 1:10 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-3918
Mailing Address - Country:US
Mailing Address - Phone:631-413-1817
Mailing Address - Fax:
Practice Address - Street 1:10 W 21ST ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-3918
Practice Address - Country:US
Practice Address - Phone:631-413-1817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY763513174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist