Healthcare Provider Details

I. General information

NPI: 1609057207
Provider Name (Legal Business Name): PAUL ANDRE LORISSAINT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2007
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 OLD ORANGEBURG RD
ORANGEBURG NY
10962-1157
US

IV. Provider business mailing address

30 NOYES AVE
SPRING VALLEY NY
10977-5739
US

V. Phone/Fax

Practice location:
  • Phone: 845-680-7800
  • Fax:
Mailing address:
  • Phone: 845-426-0576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number290264-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number781463
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: