Provider Demographics
NPI:1962558585
Name:ATTANASIO, LORI HEATHER (PA-C)
Entity type:Individual
Prefix:MISS
First Name:LORI
Middle Name:HEATHER
Last Name:ATTANASIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 REYNOLDS AVE
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-3326
Mailing Address - Country:US
Mailing Address - Phone:973-887-8080
Mailing Address - Fax:610-612-5483
Practice Address - Street 1:200 REYNOLDS AVE
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-3326
Practice Address - Country:US
Practice Address - Phone:973-887-8080
Practice Address - Fax:610-612-5483
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2205363AS0400X
NJ25MP00235700363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical