Healthcare Provider Details

I. General information

NPI: 1871896605
Provider Name (Legal Business Name): JOANNE LAZZARO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 E MAIN ST
HUNTINGTON NY
11743-2939
US

IV. Provider business mailing address

5 CEDAR CT
COPIAGUE NY
11726-4733
US

V. Phone/Fax

Practice location:
  • Phone: 631-549-3327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF305490-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: