Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 212320 | MA |
NPI | 1053350058 |
---|---|
Provider Name | Elke Lorensen |
First Address | New York, NY 10002-8024 |
Second Address | Brooklyn, NY 11203-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 07/08/2007 |