Individual
LOUISE LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
130 W KINGSBRIDGE RD, BRONX, NY 10468-3904
(718) 584-9000
Mailing address
331 DECKER AVE, STATEN ISLAND, NY 10302-2201
(917) 829-1625
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3747A065OX
VA HOSPITAL BRONX
NY
Enumeration date
10/19/2019
Last updated
10/20/2019
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