Healthcare Provider Details

I. General information

NPI: 1578883351
Provider Name (Legal Business Name): ROXANA ELENA LAZARESCU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

5645 MAIN ST
FLUSHING NY
11355-5045
US

V. Phone/Fax

Practice location:
  • Phone: 718-661-7263
  • Fax:
Mailing address:
  • Phone: 646-460-2637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number003825
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: