Healthcare Provider Details

I. General information

NPI: 1942996780
Provider Name (Legal Business Name): LAZ TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 S 17TH ST
NEWARK NJ
07103-1236
US

IV. Provider business mailing address

434 S 17TH ST
NEWARK NJ
07103-1236
US

V. Phone/Fax

Practice location:
  • Phone: 201-349-7262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: ROSCELLE J HUBBARD
Title or Position: OWNER
Credential:
Phone: 201-349-7262