Healthcare Provider Details

I. General information

NPI: 1700865854
Provider Name (Legal Business Name): ALICIA T LAZZARA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3207 FRANCIS LEWIS BLVD
FLUSHING NY
11358-1922
US

IV. Provider business mailing address

3207 FRANCIS LEWIS BLVD
FLUSHING NY
11358-1922
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-2030
  • Fax: 718-281-2617
Mailing address:
  • Phone: 718-224-2030
  • Fax: 718-281-2617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005348
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00241600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: