Provider Demographics
NPI:1083262083
Name:ALMANZAR, LAWRENCE CHAYANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:CHAYANNE
Last Name:ALMANZAR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NICOLLS RD # HSC15040
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8174
Mailing Address - Country:US
Mailing Address - Phone:631-638-0628
Mailing Address - Fax:631-865-4052
Practice Address - Street 1:101 NICOLLS RD # HSC15-040
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8174
Practice Address - Country:US
Practice Address - Phone:631-638-0628
Practice Address - Fax:631-865-4052
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
NY024037363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty