Healthcare Provider Details

I. General information

NPI: 1265685598
Provider Name (Legal Business Name): JENIFER LORRILL FARINA LUCIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HATFIELD LN STE 105
GOSHEN NY
10924-6768
US

IV. Provider business mailing address

2 COATES DR
GOSHEN NY
10924-6758
US

V. Phone/Fax

Practice location:
  • Phone: 845-291-7400
  • Fax:
Mailing address:
  • Phone: 845-651-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002172
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number014352
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: