Provider Demographics
NPI:1982904603
Name:LOEB, LAURENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:
Last Name:LOEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 E HARTSDALE AVE
Mailing Address - Street 2:1 - C
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-3544
Mailing Address - Country:US
Mailing Address - Phone:914-723-1446
Mailing Address - Fax:
Practice Address - Street 1:180 E HARTSDALE AVE
Practice Address - Street 2:1 - C
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-3544
Practice Address - Country:US
Practice Address - Phone:914-723-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY758352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry