1003398454 NPI number — LAWRENCE ANTON FERIOZZI MS, CCTP

Table of content: LAWRENCE ANTON FERIOZZI MS, CCTP (NPI 1003398454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003398454 NPI number — LAWRENCE ANTON FERIOZZI MS, CCTP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERIOZZI
Provider First Name:
LAWRENCE
Provider Middle Name:
ANTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, CCTP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003398454
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 BARTOW ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT PIERCE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-543-1443
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15818 SW WARFIELD BLVD,
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANTOWN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-597-0411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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