Provider Demographics
NPI:1255756623
Name:LANZI, ELLEN (RN)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:
Last Name:LANZI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SAINT JOSEPHS AVE
Mailing Address - Street 2:ROOM B233
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-1115
Mailing Address - Country:US
Mailing Address - Phone:718-420-2100
Mailing Address - Fax:
Practice Address - Street 1:85 SAINT JOSEPHS AVE
Practice Address - Street 2:ROOM B233
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-1115
Practice Address - Country:US
Practice Address - Phone:718-420-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY365555163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse