Healthcare Provider Details

I. General information

NPI: 1508988494
Provider Name (Legal Business Name): TAMARA ANNE LAZENBY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 BROADWAY SUITE 471
NEW YORK NY
10003-9502
US

IV. Provider business mailing address

726 BROADWAY SUITE 471
NEW YORK NY
10003-9502
US

V. Phone/Fax

Practice location:
  • Phone: 212-998-4781
  • Fax:
Mailing address:
  • Phone: 212-998-4781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number236538
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: