Healthcare Provider Details

I. General information

NPI: 1619029626
Provider Name (Legal Business Name): JAMIE LANZILLOTTA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE GARIBALDI D.O.

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 FRANKLIN PLACE FIVE TOWNS PEDIATRICS
WOODMERE NY
11598
US

IV. Provider business mailing address

145 FRANKLIN PLACE FIVE TOWNS PEDIATRICS
WOODMERE NY
11598
US

V. Phone/Fax

Practice location:
  • Phone: 516-295-1200
  • Fax: 516-295-1207
Mailing address:
  • Phone: 516-295-1200
  • Fax: 516-295-1207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberHOO63953
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number243824
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: