Provider Demographics
NPI:1063596898
Name:LANZONE, THERESA C (MD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:C
Last Name:LANZONE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:350 NATIONAL BLVD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3327
Mailing Address - Country:US
Mailing Address - Phone:516-432-0545
Mailing Address - Fax:516-432-0597
Practice Address - Street 1:350 NATIONAL BLVD
Practice Address - Street 2:SUITE 2C
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3327
Practice Address - Country:US
Practice Address - Phone:516-432-0545
Practice Address - Fax:516-432-0597
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1556682080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine