Healthcare Provider Details

I. General information

NPI: 1689064628
Provider Name (Legal Business Name): PATRICIA LAZIO R.N., N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 E 90TH ST APT 2B
NEW YORK NY
10128-0671
US

IV. Provider business mailing address

14 E 90TH ST APT 2B
NEW YORK NY
10128-0671
US

V. Phone/Fax

Practice location:
  • Phone: 212-427-1590
  • Fax:
Mailing address:
  • Phone: 212-427-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number351022-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF330255-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: