Individual
BLISS NICOLE LANZELOTTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
161 DALY RD, EAST NORTHPORT, NY 11731-6335
(516) 581-0395
Mailing address
161 DALY RD, EAST NORTHPORT, NY 11731-6335
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
023091
NY
Other
Enumeration date
12/20/2018
Last updated
12/20/2018
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