Provider Demographics
NPI:1760964811
Name:JONATHAN N LAZARE UROLOGY PC
Entity Type:Organization
Organization Name:JONATHAN N LAZARE UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:LAZARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-369-3300
Mailing Address - Street 1:1729 E 12TH ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1088
Mailing Address - Country:US
Mailing Address - Phone:718-369-3300
Mailing Address - Fax:718-369-3301
Practice Address - Street 1:1729 E 12TH ST FL 5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1088
Practice Address - Country:US
Practice Address - Phone:718-369-3300
Practice Address - Fax:718-369-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195845208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty