Provider Demographics
NPI:1063774545
Name:LORA, ERIC ERODY
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:ERODY
Last Name:LORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 RENAISSANCE CT
Mailing Address - Street 2:UNIT 16A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4606
Mailing Address - Country:US
Mailing Address - Phone:718-791-8988
Mailing Address - Fax:
Practice Address - Street 1:16 RENAISSANCE CT
Practice Address - Street 2:UNIT 16A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4606
Practice Address - Country:US
Practice Address - Phone:718-791-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist