Provider Demographics
NPI:1205866340
Name:STIUSO, LORIANN M (DO)
Entity Type:Individual
Prefix:
First Name:LORIANN
Middle Name:M
Last Name:STIUSO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LAUREL WAY
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-1941
Mailing Address - Country:US
Mailing Address - Phone:516-676-8890
Mailing Address - Fax:
Practice Address - Street 1:10 MEDICAL PLZ
Practice Address - Street 2:ROOM 301
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2193
Practice Address - Country:US
Practice Address - Phone:516-676-7116
Practice Address - Fax:516-676-6249
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1842722080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01407354Medicaid