Healthcare Provider Details

I. General information

NPI: 1588898688
Provider Name (Legal Business Name): LISA ZACCARINI TANGREDI O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ALLAN AVE
YORKTOWN HTS NY
10598-4032
US

IV. Provider business mailing address

2101 ALLAN AVE
YORKTOWN HTS NY
10598-4032
US

V. Phone/Fax

Practice location:
  • Phone: 914-924-4514
  • Fax:
Mailing address:
  • Phone: 914-924-4514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number013643
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: