Healthcare Provider Details

I. General information

NPI: 1881784239
Provider Name (Legal Business Name): JOSEPH CHARLES LAZAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 JERICHO TPKE SUITE 106
SYOSSET NY
11791
US

IV. Provider business mailing address

175 JERICHO TPKE SUITE 106
SYOSSET NY
11791
US

V. Phone/Fax

Practice location:
  • Phone: 516-496-1060
  • Fax: 516-496-1062
Mailing address:
  • Phone: 516-496-1060
  • Fax: 516-496-1062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number141697
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: