Provider Demographics
NPI:1679993802
Name:JENIELYN LAZARO
Entity type:Organization
Organization Name:JENIELYN LAZARO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENIELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZARO-PAPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-290-6804
Mailing Address - Street 1:37 DUNNIGAN DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2657
Mailing Address - Country:US
Mailing Address - Phone:845-300-2740
Mailing Address - Fax:530-364-6143
Practice Address - Street 1:1133 BROADWAY SUITE 706
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-0086
Practice Address - Country:US
Practice Address - Phone:845-300-2740
Practice Address - Fax:530-364-6143
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:L3 AGENCY HEALTHCARE RECRUITMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1324974251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health