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General NPI Number Information
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NPI Number | 1326685520
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Entity Type | Organization
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Legal Business Name | LAZARUS ENTERPRISES INC
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Dates
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Enumeration Date | 12/06/2019
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Last Update Date | 12/06/2019
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Provider Practice Location Address
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Address Line | 1 BROADWAY FL 14
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City | CAMBRIDGE
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State | MA
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Zip | 02142-1187
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Country | US
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Telephone | 617-475-1557
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BROADWAY FL 14
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City | CAMBRIDGE
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State | MA
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Zip | 02142-1187
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Country | US
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Telephone | 617-475-1557
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ARIEL ELIZAROV
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Credential |
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Telephone | 617-475-1557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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