Provider Demographics
NPI:1962765313
Name:LOREN, MIRIAM HORAK (MA)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:HORAK
Last Name:LOREN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 HARLAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-1118
Mailing Address - Country:US
Mailing Address - Phone:914-712-7470
Mailing Address - Fax:
Practice Address - Street 1:47 HARLAN DR
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-1118
Practice Address - Country:US
Practice Address - Phone:914-712-7470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY816313174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist