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General NPI Number Information
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NPI Number | 1285976738
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Entity Type | Individual
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Provider Name | LARA ZUCCONI VANYO M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/22/2013
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 175 E 96TH ST APT 12C
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City | NEW YORK
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State | NY
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Zip | 10128-6206
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Country | US
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Telephone | 650-823-3595
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Fax |
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Provider Business Mailing Address
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Address Line | 175 E 96TH ST APT 12C
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City | NEW YORK
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State | NY
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Zip | 10128-6206
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Country | US
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Telephone | 650-823-3595
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 294743
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 130453
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License Number State | OH
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