Provider Demographics
NPI:1053671941
Name:LANZA, TONI ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:TONI ANN
Middle Name:
Last Name:LANZA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 NEPTUNE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2315
Mailing Address - Country:US
Mailing Address - Phone:718-266-0814
Mailing Address - Fax:718-266-1693
Practice Address - Street 1:2401 NEPTUNE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2315
Practice Address - Country:US
Practice Address - Phone:718-266-0814
Practice Address - Fax:718-266-1693
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY513055-1163W00000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1005809Medicaid