Healthcare Provider Details

I. General information

NPI: 1174463517
Provider Name (Legal Business Name): EZEQUIEL LAFONT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

68 77TH ST
BROOKLYN NY
11209-2919
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-8264
  • Fax:
Mailing address:
  • Phone: 929-613-5377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberPROCESSING
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: