Healthcare Provider Details

I. General information

NPI: 1720157159
Provider Name (Legal Business Name): LORRAINE GUARINO-MINASSIAN PT, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 ROUTE 303 # 11 WESTSHORE PLAZA
BLAUVELT NY
10913-1105
US

IV. Provider business mailing address

580 ROUTE 303 # 11
BLAUVELT NY
10913-1105
US

V. Phone/Fax

Practice location:
  • Phone: 845-680-6655
  • Fax: 845-680-6655
Mailing address:
  • Phone: 845-680-6655
  • Fax: 845-680-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number018584
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: