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General NPI Number Information
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NPI Number | 1740593474
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Entity Type | Organization
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Legal Business Name | ISLAND NURSE PRACTITIONER IN FAMILY HEALTH, PLLC
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 3700 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-3836
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Country | US
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Telephone | 718-980-6103
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Fax |
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Provider Business Mailing Address
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Address Line | 470 MASON AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-2222
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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 | OWNER
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Name | MS. MELISSA LANZA
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Credential | NP
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Telephone | 718-980-6103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F334736
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License Number State | NY
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