Healthcare Provider Details

I. General information

NPI: 1629082235
Provider Name (Legal Business Name): MOSHE SHUMEL LAZAR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 E 2ND STREET
BROOKLYN NY
11230-5501
US

IV. Provider business mailing address

1421 E 2ND ST
BROOKLYN NY
11230-5501
US

V. Phone/Fax

Practice location:
  • Phone: 718-645-7337
  • Fax: 718-645-7373
Mailing address:
  • Phone: 718-645-7337
  • Fax: 718-645-7373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number193773
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: