Healthcare Provider Details

I. General information

NPI: 1295989788
Provider Name (Legal Business Name): ZVI LAZARUS MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 TAMMY RD
SPRING VALLEY NY
10977-1318
US

IV. Provider business mailing address

10 TAMMY RD
SPRING VALLEY NY
10977-1318
US

V. Phone/Fax

Practice location:
  • Phone: 917-968-6661
  • Fax:
Mailing address:
  • Phone: 917-968-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number024001-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: