Healthcare Provider Details

I. General information

NPI: 1932544343
Provider Name (Legal Business Name): ELISSA LAZARSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 W TAFT RD STE 202
LIVERPOOL NY
13088-2806
US

IV. Provider business mailing address

113 GORLAND AVE
SYRACUSE NY
13224-1615
US

V. Phone/Fax

Practice location:
  • Phone: 315-552-0406
  • Fax: 315-634-6230
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0218021
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: