Provider Demographics
NPI:1326685520
Name:LAZARUS ENTERPRISES INC
Entity Type:Organization
Organization Name:LAZARUS ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIZAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-475-1557
Mailing Address - Street 1:1 BROADWAY FL 14
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1187
Mailing Address - Country:US
Mailing Address - Phone:617-475-1557
Mailing Address - Fax:
Practice Address - Street 1:1 BROADWAY FL 14
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1187
Practice Address - Country:US
Practice Address - Phone:617-475-1557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service