Healthcare Provider Details

I. General information

NPI: 1215553672
Provider Name (Legal Business Name): LORNA STEPHANIE COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 GREEN BAY RD
NORTH CHICAGO IL
60064-3095
US

IV. Provider business mailing address

2649 STRANG BLVD STE 304
YORKTOWN HEIGHTS NY
10598-2938
US

V. Phone/Fax

Practice location:
  • Phone: 508-344-0900
  • Fax:
Mailing address:
  • Phone: 646-745-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number341184
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: