Healthcare Provider Details

I. General information

NPI: 1013980622
Provider Name (Legal Business Name): EMANUEL LAZAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SEGUINE AVE
STATEN ISLAND NY
10309-3720
US

IV. Provider business mailing address

15 SEGUINE AVE
STATEN ISLAND NY
10309-3720
US

V. Phone/Fax

Practice location:
  • Phone: 718-356-3838
  • Fax: 718-356-0174
Mailing address:
  • Phone: 718-356-3838
  • Fax: 718-356-0174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number170368
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: