1730164179 NPI number — DR. ROBERT MICHAEL LAZAR MD

Table of content: (NPI 1336297332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730164179 NPI number — DR. ROBERT MICHAEL LAZAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAZAR
Provider First Name:
ROBERT
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730164179
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1092 JERICHO TPKE STE 2S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMMACK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11725-3016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-543-8660
Provider Business Mailing Address Fax Number:
631-543-8661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1092 JERICHO TPKE STE 2S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMMACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11725-3016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-543-8660
Provider Business Practice Location Address Fax Number:
631-543-8661
Provider Enumeration Date:
12/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  153441 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2593739 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 71232 . This is a "GHI (HMO)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 29866 . This is a "AETNA / US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31048 . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA50365 . This is a "MDNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001755 . This is a "IND. HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0270298 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CS317 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4C3299 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3V6281 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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