Healthcare Provider Details

I. General information

NPI: 1942964572
Provider Name (Legal Business Name): ABBIE LAZARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 JEFFERSON PLZ
POUGHKEEPSIE NY
12601-4035
US

IV. Provider business mailing address

PO BOX 1322
HUDSON NY
12534-0316
US

V. Phone/Fax

Practice location:
  • Phone: 845-473-5900
  • Fax:
Mailing address:
  • Phone: 518-858-3192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number491662-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: