Healthcare Provider Details

I. General information

NPI: 1851350730
Provider Name (Legal Business Name): CARMEN LAZALA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2676B GRAND CONCOURSE
BRONX NY
10458-4962
US

IV. Provider business mailing address

97 FALMOUTH RD
SCARSDALE NY
10583-4756
US

V. Phone/Fax

Practice location:
  • Phone: 718-220-6272
  • Fax: 718-220-6270
Mailing address:
  • Phone: 718-220-6272
  • Fax: 718-220-6270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number212539
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number212539
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: