Provider Demographics
NPI:1740541549
Name:LAZAROFF, JUSTIN MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:MICHAEL
Last Name:LAZAROFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BELMONT BEHAVIORAL HOSPITAL
Mailing Address - Street 2:4200 MONUMENT RD
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1625
Mailing Address - Country:US
Mailing Address - Phone:215-877-2000
Mailing Address - Fax:888-421-6026
Practice Address - Street 1:BELMONT BEHAVIORAL HOSPITAL
Practice Address - Street 2:4200 MONUMENT RD
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1625
Practice Address - Country:US
Practice Address - Phone:215-877-2000
Practice Address - Fax:888-421-6026
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0173602084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103099387-0001Medicaid
PA103099387-0001Medicaid