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NPI Code Detail

MEDICARE: DR. CATHY JO LORE MD

MEDICARE: DR. CATHY JO LORE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry Physician190564NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1080769OTHERMATUFTS HEALTH PLAN

General Provider Information

NPI Number : 1811988363
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CATHY JO LORE MD
Provider Business Mailing Address
First Line : 46 BROOME AVE
Second Line :
City : ATLANTIC BEACH
State : NY
Zip : 11509-1214
Country : US
Telephone Number : 516-239-2453
Fax Number :
Provider Business Practice Location Address
First Line : 55 HORIZON DR
Second Line :
City : HUNTINGTON
State : NY
Zip : 11743-4436
Country : US
Telephone Number : 631-920-8000
Fax Number : 631-920-8164
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 03/28/2014

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