Healthcare Provider Details

I. General information

NPI: 1447425590
Provider Name (Legal Business Name): RONALD J. LANCZ,DPM P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W KENNEDY BLVD SUITE B5
LAKEWOOD NJ
08701-1255
US

IV. Provider business mailing address

721 W KENNEDY BLVD SUITE B5
LAKEWOOD NJ
08701-1255
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 TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD002201
License Number StateNJ

VIII. Authorized Official

Name: DR. RONALD J LANCZ
Title or Position: OWNER
Credential: DPM
Phone: 732-364-4300