Provider Demographics
NPI:1518260207
Name:BALZANO, LAUREN M (MS, RPA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:BALZANO
Suffix:
Gender:F
Credentials:MS, RPA-C
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:M
Other - Last Name:PAROLISI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RPA-C
Mailing Address - Street 1:221 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4515
Mailing Address - Country:US
Mailing Address - Phone:516-496-2752
Mailing Address - Fax:516-496-2763
Practice Address - Street 1:221 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4515
Practice Address - Country:US
Practice Address - Phone:516-496-2752
Practice Address - Fax:516-496-2763
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014454363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical