Healthcare Provider Details

I. General information

NPI: 1164123188
Provider Name (Legal Business Name): JEAN LAZAREK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 W 2ND ST
OSWEGO NY
13126-3812
US

IV. Provider business mailing address

283 W 2ND ST STE 2
OSWEGO NY
13126-3812
US

V. Phone/Fax

Practice location:
  • Phone: 315-342-4489
  • Fax: 315-343-3281
Mailing address:
  • Phone: 315-342-4489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number525612
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: