Provider Demographics
NPI:1336414911
Name:REYNALDO P. LAZARO, MD
Entity Type:Organization
Organization Name:REYNALDO P. LAZARO, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-432-8272
Mailing Address - Street 1:1 FOXCARE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2099
Mailing Address - Country:US
Mailing Address - Phone:607-432-8272
Mailing Address - Fax:607-432-7852
Practice Address - Street 1:1 FOXCARE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2099
Practice Address - Country:US
Practice Address - Phone:607-432-8272
Practice Address - Fax:607-432-7852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124398-1261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center