Lazaroff, Jerry M
Lazaroff, Jerry M is an sole proprietor health care provider with primary practice located at 1029 N Providence Rd , Media PA 19063-1404. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Lazaroff, Jerry M can be contacted via phone (610) 566-6633.Contact Information
Primary practice address
1029 N Providence Rd
Media PA 19063-1404
Phone: (610) 566-6633
Fax: (610) 566-6637
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | PS-002867-L | Pennsylvania |
Profile Details
| NPI number | 1730169343 |
|---|---|
| LBN Legal business name | Lazaroff, Jerry M |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 19th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1730169343 | NPPES |
| Other | LA1155 | PA BLUE SHIELD |
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