Provider Demographics
NPI:1801981402
Name:LORENZO, CHRISTINE VIVIAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:VIVIAN
Last Name:LORENZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 CORNELL STREET
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-274-3177
Mailing Address - Fax:
Practice Address - Street 1:953 DANBY ROAD
Practice Address - Street 2:HAMMOND HEALTH CENTER - ITHACA COLLEGE
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-274-3177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010183553OtherBLUE CHOICE PROVIDER #
NY01442768Medicaid
NYRB3570Medicare PIN
NYJ400018203Medicare PIN
NYF69637Medicare UPIN
NYK70203Medicare ID - Type Unspecified