=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295680700
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NICHOLAS LATTANZIO NURSE PRACTITIONER IN ADULT HEALTH PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2026
-----------------------------------------------------
Last Update Date | 03/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 WICKHAM RD
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11530-2516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-322-4316
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 WICKHAM RD
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11530-2516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-322-4316
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. NICHOLAS LATTANZIO
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 516-322-4316
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------