1528035706 NPI number — MARLENE K LAMBIASO MD

Table of content: MARLENE K LAMBIASO MD (NPI 1528035706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528035706 NPI number — MARLENE K LAMBIASO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAMBIASO
Provider First Name:
MARLENE
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1528035706
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
658 CAYUGA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32708-5603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-359-2213
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2555 S. KIRKMAN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-362-2030
Provider Business Practice Location Address Fax Number:
407-363-2143
Provider Enumeration Date:
03/07/2006

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: 2083P0500X , with the licence number:  ME41781 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 593607609 . This is a "TAX ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 002900000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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