Provider Demographics
NPI:1164309076
Name:LANZILLO, VINCENT MICHAEL (PA)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:MICHAEL
Last Name:LANZILLO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CROMWELL CIR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1102
Mailing Address - Country:US
Mailing Address - Phone:718-594-5668
Mailing Address - Fax:
Practice Address - Street 1:42 CROMWELL CIR
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1102
Practice Address - Country:US
Practice Address - Phone:718-594-5668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant