=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528483948
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. LORI BETH KESLOWITZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2014
-----------------------------------------------------
Last Update Date | 11/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5902 14TH AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11219-5066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-686-5900
-----------------------------------------------------
Fax | 718-853-0213
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 669 FLANDERS DRIVE
-----------------------------------------------------
City | VALLEY STREAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-729-1055
-----------------------------------------------------
Fax | 516-791-2463
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 896309
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------