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1104236199 NPI number — SEAN WAYNE LAZARUS D.P.M. LLC

NPI Number: 1104236199
Health Care Provider/Practitioner: SEAN WAYNE LAZARUS D.P.M. LLC

Information about “1104236199” NPI (SEAN WAYNE LAZARUS D.P.M. LLC) exists in 1104236199 in HTML format HTML  |  1104236199 in plain Text format TXT  |  1104236199 in PDF (Portable Document Format) PDF  |  1104236199 in an XML format XML  formats.

NPI Number : 1104236199 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104236199",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SEAN WAYNE LAZARUS D.P.M. LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "764 CAMPELLE AVE",
    "SecondLineMailingAddress": "UNIT G",
    "MailingAddressCityName": "WEST HAVEN",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06516-3786",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "475-238-7400",
    "MailingAddressFaxNumber": "475-238-7400",
    "FirstLinePracticeLocationAddress": "764 CAMPELLE AVE",
    "SecondLinePracticeLocationAddress": "UNITG",
    "PracticeLocationAddressCityName": "WEST HAVEN",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06516-3786",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "475-238-7400",
    "PracticeLocationAddressFaxNumber": "475-238-7400",
    "EnumerationDate": "04/30/2014",
    "LastUpdateDate": "09/27/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LAZARUS",
    "AuthorizedOfficialFirstName": "SEAN",
    "AuthorizedOfficialMiddleName": "WAYNE",
    "AuthorizedOfficialTitle": "DOCTOR",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "D.P.M",
    "AuthorizedOfficialTelephoneNumber": "203-453-0704",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "213EP1101X",
          "TaxonomyName": "Primary Podiatric Medicine Podiatrist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "213ES0131X",
          "TaxonomyName": "Foot Surgery Podiatrist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "213E00000X",
          "TaxonomyName": "Podiatrist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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