Healthcare Provider Details

I. General information

NPI: 1619093721
Provider Name (Legal Business Name): IONICA E LAZAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 MADISON AVE SUITE 10E
NEW YORK NY
10016-5421
US

IV. Provider business mailing address

161 MADISON AVE SUITE 10 E
NEW YORK NY
10016-5421
US

V. Phone/Fax

Practice location:
  • Phone: 646-637-3322
  • Fax: 212-353-1915
Mailing address:
  • Phone: 646-637-3322
  • Fax: 212-353-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number334193
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: