Provider Demographics
NPI:1699159038
Name:LAZAROS, JENNIFER (RN, NP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:LAZAROS
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WEST 14TH STREET
Mailing Address - Street 2:SUITE 506
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:929-777-0173
Mailing Address - Fax:
Practice Address - Street 1:115 BROADWAY STE 1800
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1652
Practice Address - Country:US
Practice Address - Phone:516-534-2375
Practice Address - Fax:512-229-0865
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY673578-1163W00000X
NY402087363LP0808X
NYF402087-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
WI331945Medicare Oscar/Certification
WI331043Medicare Oscar/Certification
WI331946Medicare Oscar/Certification
WI331952Medicare Oscar/Certification
WI331978Medicare Oscar/Certification
WI331058Medicare Oscar/Certification
WI331009Medicare Oscar/Certification
WI331954Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NY00695941Medicaid
NYW6L111Medicare Oscar/Certification
WI331944Medicare Oscar/Certification
WI331947Medicare Oscar/Certification