Provider Demographics
NPI:1073386728
Name:LUCILLE LORE, NP IN FAMILY HEALTH, PLLC
Entity type:Organization
Organization Name:LUCILLE LORE, NP IN FAMILY HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUCILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LORE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:631-972-5997
Mailing Address - Street 1:1001 HAWKINS AVE UNIT 335
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-5015
Mailing Address - Country:US
Mailing Address - Phone:631-972-5997
Mailing Address - Fax:
Practice Address - Street 1:2995 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2138
Practice Address - Country:US
Practice Address - Phone:631-615-7260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-03
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty