Healthcare Provider Details

I. General information

NPI: 1730967654
Provider Name (Legal Business Name): MR. DANIEL LAZO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 HUDSON ST
NEW YORK NY
10013-1412
US

IV. Provider business mailing address

2-10 MONTGOMERY ST APT B1
BLOOMFIELD NJ
07003-6027
US

V. Phone/Fax

Practice location:
  • Phone: 332-239-7305
  • Fax:
Mailing address:
  • Phone: 973-941-3697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number311279
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: