Provider Demographics
NPI:1053736579
Name:DELORENZO, EDWARD C (MSED)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:DELORENZO
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7616 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2412
Mailing Address - Country:US
Mailing Address - Phone:718-630-5100
Mailing Address - Fax:718-491-6110
Practice Address - Street 1:7616 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2412
Practice Address - Country:US
Practice Address - Phone:718-630-5100
Practice Address - Fax:718-491-6610
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist