Healthcare Provider Details

I. General information

NPI: 1407529167
Provider Name (Legal Business Name): KRISTEN LORCH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 MANETTO HILL RD STE 120
PLAINVIEW NY
11803-1324
US

IV. Provider business mailing address

150 ANNUSKEMUNNICA RD
BABYLON NY
11702-4403
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-3828
  • Fax:
Mailing address:
  • Phone: 631-332-8147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number345804
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: