Provider Demographics
NPI:1700899887
Name:LORENZ, VINCENT II (PA)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:LORENZ
Suffix:II
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 PARK CLUB LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5270
Mailing Address - Country:US
Mailing Address - Phone:716-204-1101
Mailing Address - Fax:716-204-0914
Practice Address - Street 1:192 PARK CLUB LN
Practice Address - Street 2:SUITE 100
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5270
Practice Address - Country:US
Practice Address - Phone:716-204-1101
Practice Address - Fax:716-204-0914
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006507363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0215OtherMEDICARE GROUP #
NYS78926Medicare UPIN