Provider Demographics
NPI:1407851082
Name:LANZONE, JOHN A (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:LANZONE
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 1:173 MINEOLA BLVD
Mailing Address - Street 2:STE 406
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2555
Mailing Address - Country:US
Mailing Address - Phone:516-877-1414
Mailing Address - Fax:516-877-7120
Practice Address - Street 1:173 MINEOLA BLVD
Practice Address - Street 2:STE 406
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2555
Practice Address - Country:US
Practice Address - Phone:516-877-1414
Practice Address - Fax:516-877-7120
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145773174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54A431Medicare ID - Type Unspecified
NYB88578Medicare UPIN