Healthcare Provider Details

I. General information

NPI: 1285672709
Provider Name (Legal Business Name): CHIOMA N LAZZ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 ROEBLING ST
BROOKLYN NY
11211-6204
US

IV. Provider business mailing address

24511 149TH RD
ROSEDALE NY
11422-2717
US

V. Phone/Fax

Practice location:
  • Phone: 718-387-6407
  • Fax:
Mailing address:
  • Phone: 718-723-1198
  • Fax: 718-723-1198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number196114
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: