Basic Information
Provider Information | |||||||||
NPI: | 1780669887 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LORBER | ||||||||
FirstName: | DANIEL | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D.,F.A.C.P. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5945 161ST ST | ||||||||
Address2: |   | ||||||||
City: | FLUSHING | ||||||||
State: | NY | ||||||||
PostalCode: | 113651414 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7187623111 | ||||||||
FaxNumber: | 7183536315 | ||||||||
Practice Location | |||||||||
Address1: | 5945 161ST ST | ||||||||
Address2: |   | ||||||||
City: | FLUSHING | ||||||||
State: | NY | ||||||||
PostalCode: | 113651414 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7187623111 | ||||||||
FaxNumber: | 7183536315 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/12/2005 | ||||||||
LastUpdateDate: | 10/07/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 119523 | NY | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
ID | Type | State | Issuer | Description | 133442196 | 01 | NY | MAGNACARE | OTHER | 133442196 | 01 | NY | UNITED HEALTHCARE | OTHER | DL07225210 | 01 | NY | EMPIRE B/C B/S | OTHER | 0364819002 | 01 | NY | CIGNA | OTHER | 28P0181 | 01 | NY | NEW YORK PRESBYTERIAN | OTHER | DS293 | 01 | NY | OXFORD | OTHER | 0C3554 | 01 | NY | PHS | OTHER | 166148 | 01 | NY | ELDERPLAN | OTHER |