Provider Demographics
NPI:1851800379
Name:NEW LIFE MALE MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:NEW LIFE MALE MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-937-9551
Mailing Address - Street 1:1577 E CHEVY CHASE DR STE 240
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4742
Mailing Address - Country:US
Mailing Address - Phone:818-937-9551
Mailing Address - Fax:818-484-2116
Practice Address - Street 1:1577 E CHEVY CHASE DR STE 240
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4742
Practice Address - Country:US
Practice Address - Phone:818-937-9551
Practice Address - Fax:818-484-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51964208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty