Healthcare Provider Details

I. General information

NPI: 1689884496
Provider Name (Legal Business Name): JOVIN OCAMPO LAZATIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 UNIVERSITY PL UNIVERSITY PAIN CENTER
NEW YORK NY
10003-4515
US

IV. Provider business mailing address

3 SERGENT CT
BERGENFIELD NJ
07621-1227
US

V. Phone/Fax

Practice location:
  • Phone: 212-604-1300
  • Fax:
Mailing address:
  • Phone: 267-235-8442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number253679
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number253679
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: