Healthcare Provider Details

I. General information

NPI: 1740300565
Provider Name (Legal Business Name): MARTIN LAZAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 DEER PARK AVE
NORTH BABYLON NY
11703-3809
US

IV. Provider business mailing address

919 DEER PARK AVE
NORTH BABYLON NY
11703-3809
US

V. Phone/Fax

Practice location:
  • Phone: 631-669-2830
  • Fax: 631-321-1979
Mailing address:
  • Phone: 631-669-2830
  • Fax: 631-321-1979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number029344
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: