Provider Demographics
NPI:1245869338
Name:LAZATIN, JUSTINE (DO)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:LAZATIN
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1045 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2511
Mailing Address - Country:US
Mailing Address - Phone:716-868-0377
Mailing Address - Fax:
Practice Address - Street 1:940 BELMONT STREET
Practice Address - Street 2:PSYCHIATRY 116A7
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:774-826-2458
Practice Address - Fax:774-826-1859
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2024-12-20
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Provider Licenses
StateLicense IDTaxonomies
MA10182342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry