Provider Demographics
NPI:1710621479
Name:LANIADO, MARIO (EMT-B, PHLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:LANIADO
Suffix:
Gender:M
Credentials:EMT-B, PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4743
Mailing Address - Country:US
Mailing Address - Phone:862-253-1406
Mailing Address - Fax:
Practice Address - Street 1:1341 E 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4743
Practice Address - Country:US
Practice Address - Phone:862-253-1406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041122246RP1900X
NY461860146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy