Provider Demographics
NPI:1538689302
Name:LAZAR, DARA MICHELLE (LICENSED MASSAGE THE)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:MICHELLE
Last Name:LAZAR
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14-17 31ST AVENUE
Mailing Address - Street 2:APT 2B
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106
Mailing Address - Country:US
Mailing Address - Phone:347-218-1641
Mailing Address - Fax:
Practice Address - Street 1:14-17 31ST AVENUE
Practice Address - Street 2:APT 2B
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106
Practice Address - Country:US
Practice Address - Phone:347-218-1641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018746225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist