Basic Information
Provider Information
NPI: 1003296807
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAMOUR
FirstName: CYNTHIA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 HEALTHY WAY
Address2:  
City: OCEANSIDE
State: NY
PostalCode: 115721551
CountryCode: US
TelephoneNumber: 5166323283
FaxNumber:  
Practice Location
Address1: 1 HEALTHY WAY
Address2:  
City: OCEANSIDE
State: NY
PostalCode: 11572
CountryCode: US
TelephoneNumber: 5162558414
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/05/2015
LastUpdateDate: 07/23/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X292717NYY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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