Provider Demographics
NPI:1720169188
Name:DURLOFSKY, LARRY (DO)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:DURLOFSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ROCK HILL RD FL 1
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2133
Mailing Address - Country:US
Mailing Address - Phone:302-598-7667
Mailing Address - Fax:
Practice Address - Street 1:160 ROCK HILL RD FL 1
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2133
Practice Address - Country:US
Practice Address - Phone:610-667-5460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005803-L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001045703Medicaid
NJ404402Medicare PIN
PA553485Medicare PIN
DE0001045703Medicaid
NJ404402DUTMedicare PIN
DE000P45V39Medicare PIN