Provider Demographics
NPI:1336566272
Name:LAZAREV, STANISLAV
Entity Type:Individual
Prefix:
First Name:STANISLAV
Middle Name:
Last Name:LAZAREV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 E 31ST ST
Mailing Address - Street 2:ACMC/HIGHLAND HOSPITAL, DEPT MEDICINE, A2 ROOM 18
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1018
Mailing Address - Country:US
Mailing Address - Phone:650-518-1032
Mailing Address - Fax:
Practice Address - Street 1:1184 5TH AVENUE, FIRST FLOOR
Practice Address - Street 2:PM-124
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1002
Practice Address - Country:US
Practice Address - Phone:646-872-9186
Practice Address - Fax:212-410-7194
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
NY298670-12085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No282N00000XHospitalsGeneral Acute Care Hospital