Provider Demographics
NPI:1679525265
Name:RAYMOND J. LANZAFAME, MD, PLLC
Entity Type:Organization
Organization Name:RAYMOND J. LANZAFAME, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANZAFAME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-266-2150
Mailing Address - Street 1:PO BOX 674
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-0674
Mailing Address - Country:US
Mailing Address - Phone:315-283-1353
Mailing Address - Fax:888-315-8004
Practice Address - Street 1:757 TITUS AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3930
Practice Address - Country:US
Practice Address - Phone:585-266-2150
Practice Address - Fax:585-544-8761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00787499Medicaid
DD5232Medicare PIN
NY00787499Medicaid
NYAA1583Medicare PIN