Organization
BERNARDITA T LAZO MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BERNARDITA T LAZO (DOCTOR)
(631) 224-4811
Entity
Organization
Contact information
Practice address
2330 UNION BLVD, ISLIP, NY 11751-3172
(631) 224-4811
(631) 224-4940
Mailing address
2330 UNION BLVD, ISLIP, NY 11751-3172
(631) 224-4811
(631) 224-4940
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
153442
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861407355
—
NY
Enumeration date
03/31/2016
Last updated
03/31/2016
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