Healthcare Provider Details

I. General information

NPI: 1518959303
Provider Name (Legal Business Name): ANTONETTA LUCY LOZUPONE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 WHITE PLAINS RD STE 500
TARRYTOWN NY
10591-5118
US

IV. Provider business mailing address

520 WHITE PLAINS RD STE 500
TARRYTOWN NY
10591-5118
US

V. Phone/Fax

Practice location:
  • Phone: 800-403-1250
  • Fax: 800-403-1250
Mailing address:
  • Phone: 800-403-1250
  • Fax: 800-403-1250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF400895
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: