Provider Demographics
NPI:1679504278
Name:LANZA, GWENDOLINE FRANCES YVONNE (MD)
Entity Type:Individual
Prefix:DR
First Name:GWENDOLINE
Middle Name:FRANCES YVONNE
Last Name:LANZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 VAL-KILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-471-8030
Mailing Address - Fax:845-229-1650
Practice Address - Street 1:4236 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538
Practice Address - Country:US
Practice Address - Phone:845-229-2196
Practice Address - Fax:845-229-1650
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1215592084P0800X
NY0376852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0045805OtherVALUE OPTIONS GHI EMPIRE
NY207234OtherMVP
12396652OtherMULTIPLAN
NY207234OtherMVP
12396652OtherMULTIPLAN