Provider Demographics
NPI:1265474837
Name:LAZATIN, ENGRACIA O (MD)
Entity Type:Individual
Prefix:DR
First Name:ENGRACIA
Middle Name:O
Last Name:LAZATIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1065 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5640
Mailing Address - Country:US
Mailing Address - Phone:516-334-7000
Mailing Address - Fax:516-334-7082
Practice Address - Street 1:1065 OLD COUNTRY RD
Practice Address - Street 2:SUITE 214
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5640
Practice Address - Country:US
Practice Address - Phone:516-334-7000
Practice Address - Fax:516-334-7082
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2010-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY193731207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03I331Medicare ID - Type Unspecified
NYF73597Medicare UPIN