Provider Demographics
NPI:1295701779
Name:LAZOW, STEWART KEITH (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:STEWART
Middle Name:KEITH
Last Name:LAZOW
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 LENOX RD
Mailing Address - Street 2:UNIVERSITY HOSPITAL BOX 76
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2017
Mailing Address - Country:US
Mailing Address - Phone:718-245-2987
Mailing Address - Fax:718-245-3577
Practice Address - Street 1:445 LENOX RD
Practice Address - Street 2:UNIVERSITY HOSPITAL BOX 76
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2017
Practice Address - Country:US
Practice Address - Phone:718-245-2987
Practice Address - Fax:718-245-3577
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0356961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01319300Medicaid
NYU30617Medicare UPIN
NY01319300Medicaid