Provider Demographics
NPI:1891726071
Name:LAZARUS, LEWIS A (PHD)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:A
Last Name:LAZARUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 E EVESHAM RD STE 209
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4509
Mailing Address - Country:US
Mailing Address - Phone:856-772-5874
Mailing Address - Fax:856-772-2318
Practice Address - Street 1:2301 E EVESHAM RD STE 209
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4509
Practice Address - Country:US
Practice Address - Phone:856-772-5874
Practice Address - Fax:856-772-2318
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-008682-L103G00000X
NJ3659103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ004374Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGY