Healthcare Provider Details

I. General information

NPI: 1255539300
Provider Name (Legal Business Name): JOSE E LLORENS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 CHAPIN TERRACE
SPRINGFIELD MA
01107-1706
US

IV. Provider business mailing address

84 CHAPIN TERRACE
SPRINGFIELD MA
01107-1706
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-6595
  • Fax: 413-733-4544
Mailing address:
  • Phone: 413-733-6595
  • Fax: 413-733-4544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number53947
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6186882
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: JOSE E LLORENS
Title or Position: PRESIDENT
Credential: MD
Phone: 413-733-6595