=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053420398
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONICA LORENZO-LATKANY M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 04/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 E 38TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-2709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-687-0265
-----------------------------------------------------
Fax | 212-687-3463
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 E 38TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-2709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-687-0265
-----------------------------------------------------
Fax | 212-687-3463
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 1922891
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------