Healthcare Provider Details

I. General information

NPI: 1679639850
Provider Name (Legal Business Name): MARK H LAZAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

573 CRANBURY RD A5
EAST BRUNSWICK NJ
08816-4026
US

IV. Provider business mailing address

573 CRANBURY RD A5
EAST BRUNSWICK NJ
08816-4026
US

V. Phone/Fax

Practice location:
  • Phone: 732-254-5101
  • Fax: 732-254-2640
Mailing address:
  • Phone: 732-254-5101
  • Fax: 732-254-2640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number42290
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: