Healthcare Provider Details

I. General information

NPI: 1700721297
Provider Name (Legal Business Name): NATHAN JOB LOWRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 BROADWAY FL 7
NEW YORK NY
10019-1580
US

IV. Provider business mailing address

4310 CRESCENT ST APT 1103
LONG ISLAND CITY NY
11101-4245
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: