Provider Demographics
NPI:1710043229
Name:LAZAROVICH, IRINA (RPA-C)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:LAZAROVICH
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944-43RD ST. #1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219
Mailing Address - Country:US
Mailing Address - Phone:718-853-1929
Mailing Address - Fax:
Practice Address - Street 1:2583 OCEAN AVENUE
Practice Address - Street 2:INFINITE MEDICAL SERVICES, PC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-743-0677
Practice Address - Fax:718-743-0679
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009320363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01-0813160OtherEMPLOYER IDENTIFICATION N