Healthcare Provider Details

I. General information

NPI: 1528700903
Provider Name (Legal Business Name): ALYSSA RENEE LORENZANA MMS, DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 PARK AVE
HUNTINGTON NY
11743-2787
US

IV. Provider business mailing address

34 DANIEL DR
GLEN COVE NY
11542-1706
US

V. Phone/Fax

Practice location:
  • Phone: 631-351-2000
  • Fax:
Mailing address:
  • Phone: 201-575-0850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number336424
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: