Healthcare Provider Details

I. General information

NPI: 1710043229
Provider Name (Legal Business Name): IRINA LAZAROVICH RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2583 OCEAN AVENUE INFINITE MEDICAL SERVICES, PC
BROOKLYN NY
11229
US

IV. Provider business mailing address

944-43RD ST. #1
BROOKLYN NY
11219
US

V. Phone/Fax

Practice location:
  • Phone: 718-743-0677
  • Fax: 718-743-0679
Mailing address:
  • Phone: 718-853-1929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009320
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: