Healthcare Provider Details

I. General information

NPI: 1841023298
Provider Name (Legal Business Name): MARIIA LAZORKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 OCEAN AVE
BROOKLYN NY
11235-3270
US

IV. Provider business mailing address

2900 OCEAN AVE
BROOKLYN NY
11235-3270
US

V. Phone/Fax

Practice location:
  • Phone: 347-400-9790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number3267793
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: