Healthcare Provider Details

I. General information

NPI: 1801424304
Provider Name (Legal Business Name): ANDREAS S LAZARIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 E 121ST ST
NEW YORK NY
10035-3523
US

IV. Provider business mailing address

198 E 121ST ST
NEW YORK NY
10035-3523
US

V. Phone/Fax

Practice location:
  • Phone: 212-801-3300
  • Fax:
Mailing address:
  • Phone: 212-801-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number322526
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: