Provider Demographics
NPI:1801150651
Name:LORENZO, PAOLA
Entity type:Individual
Prefix:MRS
First Name:PAOLA
Middle Name:
Last Name:LORENZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 CARLYLE GRN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1727
Mailing Address - Country:US
Mailing Address - Phone:917-836-3595
Mailing Address - Fax:347-562-4274
Practice Address - Street 1:47 CARLYLE GRN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1727
Practice Address - Country:US
Practice Address - Phone:917-836-3595
Practice Address - Fax:347-562-4274
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1285823174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist