Individual
GLEN LORIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
119-05 ROCKAWAY BLVD, SOUTH OZONE PARK, NY 11420-2421
(718) 843-3003
(718) 843-3504
Mailing address
119-05 ROCKAWAY BLVD, SOUTH OZONE PARK, NY 11420-2421
(718) 843-3003
(718) 843-3504
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
153712
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00778794
—
NY
Enumeration date
08/18/2006
Last updated
07/13/2012
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