Provider Demographics
NPI:1063017143
Name:SCHWARTZ, LAZAR
Entity Type:Individual
Prefix:
First Name:LAZAR
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CARTER LN UNIT 204
Mailing Address - Street 2:
Mailing Address - City:KIRYAS JOEL
Mailing Address - State:NY
Mailing Address - Zip Code:10950-9129
Mailing Address - Country:US
Mailing Address - Phone:845-782-0000
Mailing Address - Fax:
Practice Address - Street 1:13 CARTER LN UNIT 204
Practice Address - Street 2:
Practice Address - City:KIRYAS JOEL
Practice Address - State:NY
Practice Address - Zip Code:10950-9129
Practice Address - Country:US
Practice Address - Phone:845-637-7296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00719000363A00000X
NY028697363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant