Healthcare Provider Details

I. General information

NPI: 1841608007
Provider Name (Legal Business Name): FRITZ LAMOUR SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CLINTON ST SUITE 601
HEMPSTEAD NY
11550-4281
US

IV. Provider business mailing address

50 CLINTON ST SUITE 601 HEMPSTEAD
LONG ISLAND NY
11510
US

V. Phone/Fax

Practice location:
  • Phone: 516-933-0485
  • Fax: 516-933-1923
Mailing address:
  • Phone: 516-933-0485
  • Fax: 516-933-1923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number314502 DUP
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: