Provider Demographics
NPI:1730164179
Name:LAZAR, ROBERT MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:LAZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1092 JERICHO TPKE STE 2S
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3016
Mailing Address - Country:US
Mailing Address - Phone:631-543-8660
Mailing Address - Fax:631-543-8661
Practice Address - Street 1:1092 JERICHO TPKE STE 2S
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3016
Practice Address - Country:US
Practice Address - Phone:631-543-8660
Practice Address - Fax:631-543-8661
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY153441207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2593739OtherGHI
71232OtherGHI (HMO)
29866OtherAETNA / US HEALTHCARE
31048OtherVYTRA
AA50365OtherMDNY
0001755OtherIND. HEALTH
NY0270298OtherCIGNA
CS317OtherOXFORD
4C3299OtherHEALTHNET
NY3V6281OtherBLUE CHOICE
NY3V6281OtherBLUE CHOICE
CS317OtherOXFORD