Healthcare Provider Details

I. General information

NPI: 1396748083
Provider Name (Legal Business Name): PAUL LAZAR DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 3RD AVENUE 3RD FLOOR
NEW YORK NY
10021-4256
US

IV. Provider business mailing address

1317 3RD AVE FL 3
NEW YORK NY
10021-2952
US

V. Phone/Fax

Practice location:
  • Phone: 212-996-1400
  • Fax: 212-535-8606
Mailing address:
  • Phone: 212-996-1400
  • Fax: 212-535-8606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN005355-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: