Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X4015 | NY |
NPI | 1275611279 |
---|---|
Provider Name | Dr. Lorraine Delrosso |
First Address | Clifton Park, NY 12065-3804 |
Second Address | Clifton Park, NY 12065-3804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03-0509201 | EMPLOYER ID# (01) | NY |
DD3676 | WORKSMAN COMP (01) | NY |
T26668 | (02) | NY |
X4015 | STATE LICENSE # (01) | NY |