Healthcare Provider Details

I. General information

NPI: 1407176464
Provider Name (Legal Business Name): ERIC LAZAR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S BAYLES AVE
PORT WASHINGTON NY
11050-3754
US

IV. Provider business mailing address

30 S BAYLES AVE
PORT WASHINGTON NY
11050-3754
US

V. Phone/Fax

Practice location:
  • Phone: 516-883-5227
  • Fax: 516-883-6144
Mailing address:
  • Phone: 516-883-5227
  • Fax: 516-883-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number030654
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: