1508201658 NPI number — JOSE LOOR DPM LLC

Table of content: (NPI 1508201658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508201658 NPI number — JOSE LOOR DPM LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSE LOOR DPM LLC
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:
6
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:
1508201658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3607 LEHIGH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHAMPTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18067-9638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-595-7569
Provider Business Mailing Address Fax Number:
516-753-9320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 MEADOWLANDS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SECAUCUS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07094-2977
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-595-7569
Provider Business Practice Location Address Fax Number:
516-753-9320
Provider Enumeration Date:
05/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LOOR
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
347-595-7569

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  25MD00316400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 25MD00316400 . This is a "PODIATRIST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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