1275817181 NPI number — LORRAINE DEL ROSSO CHIROPRACTIC,DIETETICS,AND NUTRITION,PLLC

Table of content: (NPI 1275817181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275817181 NPI number — LORRAINE DEL ROSSO CHIROPRACTIC,DIETETICS,AND NUTRITION,PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LORRAINE DEL ROSSO CHIROPRACTIC,DIETETICS,AND NUTRITION,PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275817181
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 1153
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALLSTON LAKE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12019-0153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-899-9199
Provider Business Mailing Address Fax Number:
518-899-9199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 KENDALL WAY
Provider Second Line Business Practice Location Address:
SHOPS OF MALTA
Provider Business Practice Location Address City Name:
MALTA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-899-9199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEL ROSSO
Authorized Official First Name:
LORRAINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
518-496-2142

Provider Taxonomy Codes

  • Taxonomy code: 111NN1001X , with the licence number:  X004015-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DD5676 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".