Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 112434 | NY |
N | 2080A0000X | Adolescent Medicine | 112434 | NY |
NPI | 1063518587 |
---|---|
Provider Name | George Mitchell Lazarus |
First Address | New York, NY 10021-0302 |
Second Address | New York, NY 10021-0302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B12422 | (02) |