Healthcare Provider Details

I. General information

NPI: 1902268741
Provider Name (Legal Business Name): ELI LAZAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 E 2ND ST
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:
Mailing address:
  • Phone: 718-645-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number297645
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: