MEDICARE: DR. CHIOMA N LAZZ M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	196114	NY

General Provider Information

NPI Number	:	1285672709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHIOMA N LAZZ M.D

Provider Business Mailing Address
First Line	:	24511 149TH RD
Second Line	:
City	:	ROSEDALE
State	:	NY
Zip	:	11422-2717
Country	:	US
Telephone Number	:	718-723-1198
Fax Number	:	718-723-1198

Provider Business Practice Location Address
First Line	:	333 ROEBLING ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-6204
Country	:	US
Telephone Number	:	718-387-6407
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	05/02/2017

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