Provider Demographics
NPI:1013980622
Name:LAZAR, EMANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EMANUEL
Middle Name:
Last Name:LAZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SEGUINE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3720
Mailing Address - Country:US
Mailing Address - Phone:718-356-3838
Mailing Address - Fax:718-356-0174
Practice Address - Street 1:15 SEGUINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3720
Practice Address - Country:US
Practice Address - Phone:718-356-3838
Practice Address - Fax:718-356-0174
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170368208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics