Healthcare Provider Details

I. General information

NPI: 1881657542
Provider Name (Legal Business Name): RICHARD S LAZZARO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 05/10/2024
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 ROUTE 37 W STE 200B
TOMS RIVER NJ
08755-6400
US

IV. Provider business mailing address

67 ROUTE 37 W STE 200B
TOMS RIVER NJ
08755-6400
US

V. Phone/Fax

Practice location:
  • Phone: 732-818-3811
  • Fax: 732-818-3820
Mailing address:
  • Phone: 732-818-3811
  • Fax: 732-818-3820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA11337900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number25MA11337900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number182049
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: