Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 155668 | NY |
NPI | 1063596898 |
---|---|
Provider Name | Theresa C. Lanzone |
First Address | Long Beach, NY 11561-3327 |
Second Address | Long Beach, NY 11561-3327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |