Healthcare Provider Details

I. General information

NPI: 1174900401
Provider Name (Legal Business Name): REBECCA M LAZARUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 12/18/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E 41ST ST FL 18
NEW YORK NY
10017-6739
US

IV. Provider business mailing address

222 E 41ST ST FL 18
NEW YORK NY
10017-6739
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-8313
  • Fax: 212-263-8995
Mailing address:
  • Phone: 212-263-8313
  • Fax: 212-263-8995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number287934
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: