Healthcare Provider Details

I. General information

NPI: 1780668749
Provider Name (Legal Business Name): NERMIN A LAZARUS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 YOUNG AVE STE 146D
MOORESTOWN NJ
08057-3130
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 888-982-3726
  • Fax:
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-596-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB069022
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB06902200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: