Basic Information
| Provider Information | |||||||||
| NPI: | 1760452544 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAZZARINI | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4926 TANGLEWOOD LANE | ||||||||
| Address2: | |||||||||
| City: | MANLIUS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1537271846 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1386 STATE ROUTE 5 WEST SUITE 203 | ||||||||
| Address2: | |||||||||
| City: | CHITTENANGO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157415774 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 12/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 0101261421 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 2075561 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 02527195 | 05 | NY | MEDICAID |