Provider Demographics
NPI:1851651889
Name:LAZZARO, NICOLE K (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:K
Last Name:LAZZARO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FORRESTAL RD S STE 202
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6658
Mailing Address - Country:US
Mailing Address - Phone:609-799-6222
Mailing Address - Fax:609-799-6555
Practice Address - Street 1:8 FORRESTAL RD S STE 202
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6658
Practice Address - Country:US
Practice Address - Phone:609-799-6222
Practice Address - Fax:609-799-6555
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014733-1363A00000X
NJ25MP00344000363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant