Individual
LORI L ROUGHTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
33 MONTAUK HWY, BOX 1555, QUOGUE, NY 11959-4000
(631) 653-6000
(631) 653-8310
Mailing address
33 MONTAUK HWY, BOX 1555, QUOGUE, NY 11959-4000
(631) 653-6000
(631) 653-8310
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
30306135
NY
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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