Provider Demographics
NPI:1255192498
Name:LORA, DENNYS (MD)
Entity type:Individual
Prefix:MISS
First Name:DENNYS
Middle Name:
Last Name:LORA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:DENNYS
Other - Middle Name:
Other - Last Name:LORA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1560 BOONE AVE APT 14F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-5846
Mailing Address - Country:US
Mailing Address - Phone:646-750-2383
Mailing Address - Fax:
Practice Address - Street 1:1560 BOONE AVE APT 14F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-5846
Practice Address - Country:US
Practice Address - Phone:646-750-2383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001485-P.A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant