Healthcare Provider Details

I. General information

NPI: 1942953005
Provider Name (Legal Business Name): SARAH J LAZARUS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2022
Last Update Date: 01/30/2022
Certification Date: 01/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 CARROLL ST
BROOKLYN NY
11215-8616
US

IV. Provider business mailing address

4407 4TH AVE APT C4
BROOKLYN NY
11220-1141
US

V. Phone/Fax

Practice location:
  • Phone: 917-254-9751
  • Fax:
Mailing address:
  • Phone: 917-254-9751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number018026
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: