Provider Demographics
NPI:1700865854
Name:LAZZARA, ALICIA T (DPM)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:T
Last Name:LAZZARA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1922
Mailing Address - Country:US
Mailing Address - Phone:718-224-2030
Mailing Address - Fax:718-281-2617
Practice Address - Street 1:3207 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1922
Practice Address - Country:US
Practice Address - Phone:718-224-2030
Practice Address - Fax:718-281-2617
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005348213E00000X
NJ25MD00241600213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01979079Medicaid
NY03475JMedicare PIN
NY01979079Medicaid