Provider Demographics
NPI:1306878715
Name:STEUERWALD, LORI J (PA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:STEUERWALD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-2929
Mailing Address - Country:US
Mailing Address - Phone:585-546-2771
Mailing Address - Fax:585-454-7001
Practice Address - Street 1:114 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-2929
Practice Address - Country:US
Practice Address - Phone:585-546-2771
Practice Address - Fax:585-454-7001
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02081749Medicaid
NYS89744Medicare UPIN
NY02081749Medicaid