Healthcare Provider Details

I. General information

NPI: 1619954302
Provider Name (Legal Business Name): RONALD J LANCZ DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 RIVER AVENUE BUILDING B SUITE #303
LAKEWOOD NJ
08701
US

IV. Provider business mailing address

105 RIVER AVE BUILDING B SUITE #303
LAKEWOOD NJ
08701-4267
US

V. Phone/Fax

Practice location:
  • Phone: 732-364-4300
  • Fax: 732-886-7363
Mailing address:
  • Phone: 732-364-4300
  • Fax: 732-886-7363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD002201
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: