MEDICARE: DR. MOSHE SHUMEL LAZAR DO

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	193773	NY

General Provider Information

NPI Number	:	1629082235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOSHE SHUMEL LAZAR DO

Provider Business Mailing Address
First Line	:	1421 E 2ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5501
Country	:	US
Telephone Number	:	718-645-7337
Fax Number	:	718-645-7373

Provider Business Practice Location Address
First Line	:	1421 E 2ND STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5501
Country	:	US
Telephone Number	:	718-645-7337
Fax Number	:	718-645-7373

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/15/2019

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