Provider Demographics
NPI:1225448715
Name:OTTAVIANO, LORENZO (MD)
Entity Type:Individual
Prefix:
First Name:LORENZO
Middle Name:
Last Name:OTTAVIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0988
Mailing Address - Country:US
Mailing Address - Phone:631-707-3677
Mailing Address - Fax:
Practice Address - Street 1:60 GRAMERCY PARK N STE 1M
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5423
Practice Address - Country:US
Practice Address - Phone:212-254-2777
Practice Address - Fax:212-254-1387
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289989-1207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine