Healthcare Provider Details

I. General information

NPI: 1124145735
Provider Name (Legal Business Name): MACARTHUR RUELOS LAZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

55 HIGHVIEW DR
CLIFTON NJ
07013-3319
US

V. Phone/Fax

Practice location:
  • Phone: 121-256-2638
  • Fax: 121-256-2842
Mailing address:
  • Phone: 973-778-6553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number134619
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: