Provider Demographics
NPI:1689653495
Name:LAZZARA, JOHN FRANCIS (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANCIS
Last Name:LAZZARA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8684 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3409
Mailing Address - Country:US
Mailing Address - Phone:718-232-0704
Mailing Address - Fax:718-232-3256
Practice Address - Street 1:8684 15TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3409
Practice Address - Country:US
Practice Address - Phone:718-232-0703
Practice Address - Fax:718-232-3256
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01755595Medicaid
NY01755595Medicaid
NYG51270Medicare UPIN