Provider Demographics
NPI:1437468865
Name:LAMPASONA, MICHAEL V (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:V
Last Name:LAMPASONA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 ROUTE 25A
Mailing Address - Street 2:SUITE 225
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8802
Mailing Address - Country:US
Mailing Address - Phone:631-744-3671
Mailing Address - Fax:632-174-4625
Practice Address - Street 1:333 ROUTE 25A
Practice Address - Street 2:SUITE 225
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8802
Practice Address - Country:US
Practice Address - Phone:631-744-3671
Practice Address - Fax:631-744-6205
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY559070367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
A400036892Medicare PIN