Healthcare Provider Details

I. General information

NPI: 1558732594
Provider Name (Legal Business Name): ALISON LAZARUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 ADAM CLAYTON POWELL JR BLVD
NEW YORK NY
10027-4990
US

IV. Provider business mailing address

590 AVENUE OF THE AMERICAS ATTN: MST CAN- FAST
NEW YORK NY
10011-2022
US

V. Phone/Fax

Practice location:
  • Phone: 718-772-0259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number098603
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: