Provider Demographics
NPI:1265616452
Name:WEBER, LORI (NPRN)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:NPRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1090
Mailing Address - Country:US
Mailing Address - Phone:631-659-1700
Mailing Address - Fax:631-659-1743
Practice Address - Street 1:59 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1090
Practice Address - Country:US
Practice Address - Phone:631-659-1700
Practice Address - Fax:631-659-1743
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303859363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care