Healthcare Provider Details

I. General information

NPI: 1265615918
Provider Name (Legal Business Name): FLORENCE LAZAROFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TZVETA HRISTOVA LAZAROVA-PETKOVA M.D.

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 EMERALD PL
ROCK HILL NY
12775-6049
US

IV. Provider business mailing address

155 CRYSTAL RUN RD
MIDDLETOWN NY
10941-4028
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-6999
  • Fax: 845-703-6297
Mailing address:
  • Phone: 845-703-6999
  • Fax: 845-703-6297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number250174
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: