Healthcare Provider Details

I. General information

NPI: 1336184167
Provider Name (Legal Business Name): LAZARO LEZCANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

PO BOX 27842
NEW YORK NY
10087
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1033
  • Fax: 516-437-4167
Mailing address:
  • Phone: 718-670-1651
  • Fax: 516-437-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number177192
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: