Healthcare Provider Details

I. General information

NPI: 1114086121
Provider Name (Legal Business Name): JOHN WAYNE LAZAR PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMUNITY DR
MANHASSET NY
11030-3816
US

IV. Provider business mailing address

155 KENSINGTON RD S
GARDEN CITY NY
11530-5614
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-3054
  • Fax: 516-562-2830
Mailing address:
  • Phone: 516-524-8214
  • Fax: 516-292-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6344
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: