Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 210005 | NY |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 210005 | NY |
NPI | 1801976378 |
---|---|
Provider Name | George Lazarou |
First Address | Mineola, NY 11501-4064 |
Second Address | Mineola, NY 11501-4064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 05/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01990674 | (05) | NY |
H07262 | (02) | NY |