Provider Demographics
NPI:1255539300
Name:JOSE E LLORENS MD PC
Entity type:Organization
Organization Name:JOSE E LLORENS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LLORENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-733-6595
Mailing Address - Street 1:84 CHAPIN TERRACE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1706
Mailing Address - Country:US
Mailing Address - Phone:413-733-6595
Mailing Address - Fax:413-733-4544
Practice Address - Street 1:84 CHAPIN TERRACE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1706
Practice Address - Country:US
Practice Address - Phone:413-733-6595
Practice Address - Fax:413-733-4544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53947208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6186882Medicaid
MA6186882Medicaid