Healthcare Provider Details

I. General information

NPI: 1861261307
Provider Name (Legal Business Name): LILIA B LORENZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2023
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N 6TH AVE
MANVILLE NJ
08835-1506
US

IV. Provider business mailing address

30 N 6TH AVE
MANVILLE NJ
08835-1506
US

V. Phone/Fax

Practice location:
  • Phone: 732-763-3959
  • Fax:
Mailing address:
  • Phone: 732-763-3959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: