Individual
MYRA CELESTE LAZZARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
695 US HIGHWAY 46, SUITE 400A, FAIRFIELD, NJ 07004-1592
(973) 894-1263
(888) 972-3703
Mailing address
PO BOX 4059, WAYNE, NJ 07474-4059
(973) 894-1263
(888) 972-3703
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
MA052978
PA
363AS0400X
Surgical Physician Assistant
Primary
25MP00302000
NJ
Other
Enumeration date
04/09/2007
Last updated
01/19/2017
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