Provider Demographics
NPI:1154638211
Name:ANGEL LAZO MD, PA
Entity Type:Organization
Organization Name:ANGEL LAZO MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-963-9919
Mailing Address - Street 1:PO BOX 4335
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-0335
Mailing Address - Country:US
Mailing Address - Phone:908-963-9919
Mailing Address - Fax:201-392-3514
Practice Address - Street 1:55 MEADOWLANDS PKWY FL 3
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2977
Practice Address - Country:US
Practice Address - Phone:201-978-7740
Practice Address - Fax:201-392-3514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA70523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8394709Medicaid
043798Medicare PIN
NJ8394709Medicaid