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General NPI Number Information
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NPI Number | 1457331506
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Entity Type | Individual
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Provider Name | JAIME LAZO LIGOT M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 394 UNIVERSITY AVE
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City | NEWARK
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State | NJ
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Zip | 07102-1221
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Country | US
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Telephone | 973-733-5300
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Fax | 973-733-4328
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Provider Business Mailing Address
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Address Line | 103 W NORTHFIELD RD
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City | LIVINGSTON
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State | NJ
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Zip | 07039-3738
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Country | US
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Telephone | 973-994-1347
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA05369700
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License Number State | NJ
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