Healthcare Provider Details

I. General information

NPI: 1740541549
Provider Name (Legal Business Name): JUSTIN MICHAEL LAZAROFF D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BELMONT BEHAVIORAL HOSPITAL 4200 MONUMENT RD
PHILADELPHIA PA
19131-1625
US

IV. Provider business mailing address

BELMONT BEHAVIORAL HOSPITAL 4200 MONUMENT RD
PHILADELPHIA PA
19131-1625
US

V. Phone/Fax

Practice location:
  • Phone: 215-877-2000
  • Fax: 888-421-6026
Mailing address:
  • Phone: 215-877-2000
  • Fax: 888-421-6026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS017360
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: