Provider Demographics
NPI:1124472113
Name:LODICO, LORIANNE
Entity type:Individual
Prefix:MISS
First Name:LORIANNE
Middle Name:
Last Name:LODICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 REGIS DR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1428
Mailing Address - Country:US
Mailing Address - Phone:917-379-8276
Mailing Address - Fax:
Practice Address - Street 1:245 REGIS DR
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1428
Practice Address - Country:US
Practice Address - Phone:917-379-8276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-16
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY794215174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist