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General NPI Number Information
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NPI Number | 1336278407
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Entity Type | Individual
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Provider Name | CHRISTIAN ANTHONY LORENTZEN R-PAC
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 207 GLEN COVE AVE
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City | SEA CLIFF
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State | NY
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Zip | 11579-1437
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Country | US
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Telephone | 631-265-5858
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Fax |
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Provider Business Mailing Address
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Address Line | 11 RUDYS LN
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City | CORAM
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State | NY
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Zip | 11727-2324
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Country | US
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Telephone | 631-513-9887
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 007869
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License Number State | NY
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