Provider Demographics
NPI:1619029626
Name:LANZILLOTTA, JAMIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:LANZILLOTTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:GARIBALDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:145 FRANKLIN PLACE
Mailing Address - Street 2:FIVE TOWNS PEDIATRICS
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598
Mailing Address - Country:US
Mailing Address - Phone:516-295-1200
Mailing Address - Fax:516-295-1207
Practice Address - Street 1:145 FRANKLIN PLACE
Practice Address - Street 2:FIVE TOWNS PEDIATRICS
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598
Practice Address - Country:US
Practice Address - Phone:516-295-1200
Practice Address - Fax:516-295-1207
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHOO63953208000000X
NY243824208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04013636Medicaid