Most Relevant Information
Provider Data
| NPI Number: | 1003330283 |
| Provider Name: | LORI AVERY |
| Entity Type: | Individual |
| Taxonomy Code: | 174400000X |
| Specialty: | Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/31/2017 |
| Last Updated: | 07/31/2017 |
Provider Practice Location
23 MARLOW RD
VALLEY STREAM
NY
115803705
Practice Location Phone/Fax
| Phone: | 5168847742 |
| Fax: |
Provider Mailing Location
23 MARLOW RD
VALLEY STREAM
NY
115803705
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |