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General NPI Number Information
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NPI Number | 1114499787
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Entity Type | Individual
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Provider Name | BLISS NICOLE LANZELOTTI PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 161 DALY RD
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-6335
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Country | US
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Telephone | 516-581-0395
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Fax |
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Provider Business Mailing Address
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Address Line | 161 DALY RD
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-6335
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 023091
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License Number State | NY
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