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General NPI Number Information
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NPI Number | 1811995384
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Entity Type | Individual
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Provider Name | LORI A LUNDBERG DPM
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Gender | Female
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 1014 OSWEGATCHIE TRAIL RD
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City | STAR LAKE
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State | NY
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Zip | 13690-3143
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Country | US
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Telephone | 315-848-5404
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Fax | 315-848-3285
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Provider Business Mailing Address
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Address Line | 325 LARK ST
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City | ALBANY
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State | NY
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Zip | 12208-3501
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Country | US
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Telephone | 518-542-0582
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N005411-1
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License Number State | NY
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