Healthcare Provider Details

I. General information

NPI: 1710376355
Provider Name (Legal Business Name): BARBIE LAZAR RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 PINE TREE DR APT 1829
MIAMI BEACH FL
33140-3628
US

IV. Provider business mailing address

4101 PINE TREE DR APT 1829
MIAMI BEACH FL
33140-3628
US

V. Phone/Fax

Practice location:
  • Phone: 908-578-6476
  • Fax:
Mailing address:
  • Phone: 305-978-7718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND6263
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: