Provider Demographics
NPI:1629001722
Name:GEHRING, LAZARUS B (MD)
Entity Type:Individual
Prefix:
First Name:LAZARUS
Middle Name:B
Last Name:GEHRING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 HOOPER RD
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-3646
Mailing Address - Country:US
Mailing Address - Phone:607-754-3863
Mailing Address - Fax:607-754-5697
Practice Address - Street 1:415 HOOPER RD
Practice Address - Street 2:ENDWELL FAMILY PHYSICIANS LLP
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-3646
Practice Address - Country:US
Practice Address - Phone:607-754-3863
Practice Address - Fax:607-754-5697
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
391489OtherMVP SELECT
4210330OtherAETNA HMO
10067080OtherCDPHP
142521OtherEMPIRE BS
142521OtherEXCELLUS
142521OtherBS CNY
NY0043417OtherCHAMPUS
NY02127957Medicaid
142521OtherHMO BLUE
7633322OtherAETNA
391489OtherMVP
5997177OtherGHI
142521OtherBLUEPOINT
70145OtherGHI HMO
142521OtherHMO BLUE
DD2533Medicare ID - Type Unspecified