Basic Information
| Provider Information | |||||||||
| NPI: | 1225150907 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAZAROU | ||||||||
| FirstName: | STAVROS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 NORTHERN BLVD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110215206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164664128 | ||||||||
| FaxNumber: | 5164821822 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 NORTHERN BLVD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110215206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164664128 | ||||||||
| FaxNumber: | 5164821822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 221354 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 02196481 | 05 | NY | MEDICAID |