Provider Demographics
NPI:1871909499
Name:LAZARE, DIANA
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:LAZARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ARGYLE RD
Mailing Address - Street 2:APT. RB4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-5459
Mailing Address - Country:US
Mailing Address - Phone:646-261-8213
Mailing Address - Fax:
Practice Address - Street 1:1311 55TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4202
Practice Address - Country:US
Practice Address - Phone:646-261-8213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY843405141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist