Healthcare Provider Details

I. General information

NPI: 1053350058
Provider Name (Legal Business Name): ELKE LORENSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1809
US

IV. Provider business mailing address

275 CLINTON ST APT.# 2-6
NEW YORK NY
10002-8024
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-5421
  • Fax:
Mailing address:
  • Phone: 718-604-5421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number212320
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: