Provider Demographics
NPI:1902920010
Name:LADJAHASAN, LOREMAR NERO
Entity Type:Individual
Prefix:
First Name:LOREMAR
Middle Name:NERO
Last Name:LADJAHASAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 PELL PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10464-4927
Mailing Address - Country:US
Mailing Address - Phone:646-309-8858
Mailing Address - Fax:317-388-0805
Practice Address - Street 1:3041 BRIGHTON 2ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7453
Practice Address - Country:US
Practice Address - Phone:718-484-3131
Practice Address - Fax:347-702-9107
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist