Provider Demographics
NPI:1528483948
Name:KESLOWITZ, LORI BETH
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:BETH
Last Name:KESLOWITZ
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 1:669 FLANDERS DRIVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581
Mailing Address - Country:US
Mailing Address - Phone:516-729-1055
Mailing Address - Fax:516-791-2463
Practice Address - Street 1:5902 14TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5066
Practice Address - Country:US
Practice Address - Phone:718-686-5900
Practice Address - Fax:718-853-0213
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY896309174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist