Provider Demographics
NPI:1811544513
Name:LAZARUS, BETHANY LYNNE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:LYNNE
Last Name:LAZARUS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2890 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1114
Mailing Address - Country:US
Mailing Address - Phone:716-807-7337
Mailing Address - Fax:716-213-4400
Practice Address - Street 1:2890 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-1114
Practice Address - Country:US
Practice Address - Phone:716-807-7337
Practice Address - Fax:716-213-4400
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY023883363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant