Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 124398-1 | NY |
NPI | 1679682256 |
---|---|
Provider Name | Dr. Reynaldo P Lazaro |
First Address | Oneonta, NY 13820-1855 |
Second Address | Oneonta, NY 13820-1855 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 30/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00622940 | (05) | NY |
B03177 | (02) | NY |