Provider Demographics
NPI:1679639850
Name:LAZAR, MARK H (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:LAZAR
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 1:573 CRANBURY RD
Mailing Address - Street 2:A5
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4026
Mailing Address - Country:US
Mailing Address - Phone:732-254-5101
Mailing Address - Fax:732-254-2640
Practice Address - Street 1:573 CRANBURY RD
Practice Address - Street 2:A5
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4026
Practice Address - Country:US
Practice Address - Phone:732-254-5101
Practice Address - Fax:732-254-2640
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ422902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4245241OtherAETNA PIN
NJ50389OtherEMPIRE BC BS
NJE13111Medicare UPIN
NJ058620Medicare ID - Type Unspecified