Provider Demographics
NPI:1073719639
Name:LORENZ, NICOLE DANIELLE (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DANIELLE
Last Name:LORENZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4401 MIDDLE SETTLEMENT RD STE 210
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-5332
Mailing Address - Country:US
Mailing Address - Phone:315-738-4901
Mailing Address - Fax:315-624-7699
Practice Address - Street 1:4401 MIDDLE SETTLEMENT RD STE 210
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-5332
Practice Address - Country:US
Practice Address - Phone:315-738-4901
Practice Address - Fax:315-624-7699
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD156731208600000X
MT76921208600000X
MI4301090377208600000X
NY327194208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery