Healthcare Provider Details

I. General information

NPI: 1639685829
Provider Name (Legal Business Name): HARRIET(CHANA) LAZAROFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 OLYMPIA LN
MONSEY NY
10952-2829
US

IV. Provider business mailing address

23 CALVERT DR UNIT 202
MONSEY NY
10952-2165
US

V. Phone/Fax

Practice location:
  • Phone: 410-209-7754
  • Fax:
Mailing address:
  • Phone: 845-406-4614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007248
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: