MEDICARE: DR. NERMIN A LAZARUS 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	207Q00000X	Family Medicine Physician	MB069022	NJ
2	207Q00000X	Family Medicine Physician	25MB06902200	NJ

General Provider Information

NPI Number	:	1780668749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NERMIN A LAZARUS DO

Provider Business Mailing Address
First Line	:	301 LIPPINCOTT DR STE 410
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-4197
Country	:	US
Telephone Number	:	856-355-0340
Fax Number	:	856-596-0420

Provider Business Practice Location Address
First Line	:	401 YOUNG AVE STE 146D
Second Line	:
City	:	MOORESTOWN
State	:	NJ
Zip	:	08057-3130
Country	:	US
Telephone Number	:	888-982-3726
Fax Number	:

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	08/07/2024

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