Healthcare Provider Details

I. General information

NPI: 1801976378
Provider Name (Legal Business Name): GEORGE LAZAROU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MINEOLA BLVD SUITE 100
MINEOLA NY
11501-4064
US

IV. Provider business mailing address

120 MINEOLA BLVD SUITE 100
MINEOLA NY
11501-4064
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-3010
  • Fax: 516-663-3026
Mailing address:
  • Phone: 516-663-3010
  • Fax: 516-663-3026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number210005
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number210005
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: