Provider Demographics
NPI:1316143209
Name:LATERZA, ALISSA DANDRILLI (LMT)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:DANDRILLI
Last Name:LATERZA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:
Other - Last Name:DANDRILLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:34 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3804
Mailing Address - Country:US
Mailing Address - Phone:631-871-7938
Mailing Address - Fax:
Practice Address - Street 1:34 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3804
Practice Address - Country:US
Practice Address - Phone:631-871-7938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021091-1225700000X
NY001282-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0273137506-8OtherHEALTHCARE PROVIDERS SERVICE ORGANIZATION