Provider Demographics
NPI:1356560304
Name:LAZARUS, SARAH (PA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LAZARUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 OLD SHORT HILLS RD
Mailing Address - Street 2:STE 204
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1000
Mailing Address - Country:US
Mailing Address - Phone:973-325-7779
Mailing Address - Fax:973-325-7914
Practice Address - Street 1:101 OLD SHORT HILLS RD
Practice Address - Street 2:STE 204
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1000
Practice Address - Country:US
Practice Address - Phone:973-325-7779
Practice Address - Fax:973-325-7914
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010960-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYLICENSEOther010960-1