Provider Demographics
NPI:1639297203
Name:NERMIN LAZARUS, DO LLC
Entity Type:Organization
Organization Name:NERMIN LAZARUS, DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NERMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZARUS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-596-4470
Mailing Address - Street 1:100 BRICK RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2146
Mailing Address - Country:US
Mailing Address - Phone:856-596-4470
Mailing Address - Fax:856-596-0420
Practice Address - Street 1:100 BRICK RD
Practice Address - Street 2:SUITE 210
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2146
Practice Address - Country:US
Practice Address - Phone:856-596-4470
Practice Address - Fax:856-596-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB069022207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJHO5701Medicare UPIN