Provider Demographics
NPI:1194103200
Name:SEAN WAYNE LAZARUS DPM LLC
Entity type:Organization
Organization Name:SEAN WAYNE LAZARUS DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:LAZARUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-453-0704
Mailing Address - Street 1:920 LITTE MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437
Mailing Address - Country:US
Mailing Address - Phone:203-453-0704
Mailing Address - Fax:203-453-0704
Practice Address - Street 1:920 LITTLE MEADOW RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-1649
Practice Address - Country:US
Practice Address - Phone:203-453-0704
Practice Address - Fax:203-453-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty