Healthcare Provider Details

I. General information

NPI: 1841968153
Provider Name (Legal Business Name): SARAH LAZATIN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BRYSON AVE
STATEN ISLAND NY
10314-1923
US

IV. Provider business mailing address

200 BRYSON AVE
STATEN ISLAND NY
10314-1923
US

V. Phone/Fax

Practice location:
  • Phone: 347-576-3062
  • Fax:
Mailing address:
  • Phone: 347-576-3062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number026224
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: