Healthcare Provider Details

I. General information

NPI: 1225150907
Provider Name (Legal Business Name): DR. STAVROS LAZAROU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 10/03/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHERN BLVD SUITE 106
GREAT NECK NY
11021-5206
US

IV. Provider business mailing address

600 NORTHERN BLVD SUITE 106
GREAT NECK NY
11021-5206
US

V. Phone/Fax

Practice location:
  • Phone: 516-466-4128
  • Fax: 516-482-1822
Mailing address:
  • Phone: 516-466-4128
  • Fax: 516-482-1822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number221354
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MB11785700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: