Healthcare Provider Details

I. General information

NPI: 1508283037
Provider Name (Legal Business Name): CAROLINE LAZUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 CLARKSVILLE RD STE 4A
PRINCETON JUNCTION NJ
08550-5300
US

IV. Provider business mailing address

175 E HAWTHORN PKWY STE 235
VERNON HILLS IL
60061-1454
US

V. Phone/Fax

Practice location:
  • Phone: 732-982-2888
  • Fax: 847-859-5885
Mailing address:
  • Phone: 732-982-2888
  • Fax: 847-859-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1067287
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: